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7OFFICE <br /> ,�FOIL E: APPLICATION FOR SANITATION PIERMIT <br /> Permit No. . S... <br /> ... ....... <br /> ---- �� . <br />.................. (Complete in Triplicate) <br /> Date Issued <br /> This Permit Expires 1 Year From Date issued <br />............-•............................•.............:. <br /> stru' <br /> and <br /> herein <br /> rict <br /> it to con, <br /> Application is hereby mode to the San Joaquin with Cov nytord ordinancefor <br /> NO.Nom549 and existing g Rulestand thework <br /> ons. <br /> -described. This application is made in compliance1 <br /> ......CENSUS TRACT <br /> JOB ADDRESS/LOCATION <br /> Owner's Name ------- .....�_.._. ..._....---•- -- <br /> srta-�c� <br /> � C <br /> _.....-_.. city ......:...•. ems~�. <br /> Address .._ • .. c�7. License # �.�-o�ne <br /> ....... <br /> 0,3 <br /> . ........ <br /> Contractor's Name . g. <br /> Installation will serve: Residence 0 Apartment House Commercial Wrailer Court 0i <br /> Motel ❑Other ------_-------- ................ ...... <br /> Garbage Grinder <br /> t Lot Size ........................ , <br /> Number of livingunits•..- Number of bedrooms _ --- 9 <br /> -------• r v � r I <br /> . P i ate <br /> Water Supply: Public System and name .-----•---...................... <br /> ------..................................I.............. <br /> Character of sail to a depth of 3 feet: Sand 0S#It❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan <br /> Adobe;9 Fill Material ............if yes,type ............... ............ <br /> (plot plan, showing size of tot, location of system In relation.to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit :permitted if public sewer is available within 208 feet,) <br /> PACKAGE TREATMENT [ 7 SEPTIC TANK Size__.:. �s <br /> x15...% Liquid Depth .._.5d.�:.�•-..:..._.. <br /> -- - 'No. Com artments --=`� .� <br /> - Type )p Material. Com-,._-.... p <br /> Capacity/ �'- Yp <br /> Fovnda#ion ......l..C7.:....._ Prop. Line 4 <br /> Distance.to nearest: Well ------A .-•----••......• r , 8 <br /> :;I ... .... . ........... <br /> '. of Lines -----•:•/----------- g -0--•••• --- Total Length <br /> . Len th of each line----•-----!�-••• <br /> LEACHING LINE No th .Filter Material ............./...�-�••..`' <br /> D' Box ....f..... Type Filter Material-S�:k--- Dep <br /> ... Foundation ,C'......... Property Line ---�............... <br /> k <br /> Distance to nearest: Well _..,tom-�?..'.--•-• ---•---'l <br /> SEEPAGE PIT De / ` .�. Number __-./.............. Rock Filled Yes X No Oe <br /> is <br /> (j Depth __.._�A_.... Diameter -- r, <br /> �-*f!�....... .._ fC <br /> Water Table Depth -------------- -----•-•-- ---•----Rock Size -....._...... _. ... _.., v► <br /> k --- <br /> Dista! nce to Weare!#: Well --•.l' p•..... •--.. .---Foundation .---eg....... Prop. Line _....3_....... ....-y <br /> I t <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --- <br /> Date .. --•---••---•---- <br /> r <br /> i .................,........_....._....---..._.__.. <br /> I , <br /> Septic Tank (Specify Requirements[ ----------------•--..----------------......,-----------------••-----•----------••---•----- <br /> Disposal Field {Specify 'Requirements) ------------• --------------------- ...........................................•----•-----•-......_.._...-.-- <br /> 4 -------------------••----•----------- ----------- ----------­------- ------•-------....-------------------------- <br /> 's . <br /> ------ -----------------------------------�� (Draw existing and required addition on reverse side) <br /> 1'+hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State'Laws, and Rules and Regulations of the Son Joaquin Local HealW,01strict. Home owner or llcen- <br /> sed agents signature certifies the following: arson In such manner <br /> "I certify that in the perfermance of the work for which this permit is issued, I shall not employ any p <br /> as to become suble t L, 7- <br /> orkman's Compensation laws of California." <br /> Owner <br /> Signed �... <br /> (If other than owner) <br /> F DEP RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _�_. .,f_ --- - - <br /> DATE . .. D "------------ <br /> BUILDING-PERMIT ISSUED .------........... <br /> ..r��....------•------------------------------------......_.. " ..-_.DATE . -• -- <br /> Ala#]#TIONAL COMMENTS . .....--- <br /> , <br /> .._ .......... <br /> . <br /> ;_... -- - <br /> - - ----- -- - - -- -•---_.. ...._.. ------ <br /> .. - t-- - ---- ---- : <br /> _ -�f..._. . <br /> f <br /> #sinal Inspection b <br /> Eli 13 24 1•-68 V. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />