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FOR OFFICE USE: APPLICATION FOR SANITATION PERM;IT � � s� <br /> .......... ..................... � <br /> Permit-No. �6-•-�....---.. <br />_... __^...---•�-•-• lCompleteInTriplicates <br /> .....--- <br /> -••-•.--•• A p Date issued .7.� ..._.. v <br /> This Permit Expires 1 Year From Date Issued <br /> eflein <br /> Application is hereby made to the San Joaquin iiancec wi heaCountty tOrdt arnce Nom549 a d existingcrRulesfalnd hRegulat onst <br /> described. this application is made in c p <br /> {/ CENSUS TRACT ........................... <br /> 3. ......... . ......... - <br /> OB ADDRESS/LOCA N .�.. ......Phone ........................... /(y <br /> Owner's Name •-........ __ .. • .. ............ . . <br /> ' �. ....__. City .. ...�... � <br /> Address ................ w Pon --•-- <br /> �C cess 1� . <br /> _. ryii -3�r <br /> Contractor's Name <br /> Phone <br /> n , House Cmercial{]Troller Court 0 <br /> Installation will serve: Residence Q Apartment H om_ - <br /> Motel']Other .Gf _.. . --• --* <br /> Number of'13edrooms :. - ....Garbage Grinder ............ Lot Size ............................. ;: <br /> Number of living units:.. .Private 0 <br /> Water Supply- Public System and name ' --Y �'�----.---- . <br /> • � _ y . Cla Loam Q <br /> Character of soil to a depth of 3 feet:—Sand-0- Slit 0 CIa [0 Peat'❑ Bandy Loam{� Y } l <br /> Hardpan p Adobe: Fill Material .......... . If yes,type............... ............ 3 { <br /> {Piot pian, showing size of lot, location of system in relation to wells, buildings, ate. must be placed en reverse side;l <br /> NEW INSTALLATION- ;Na septic tank of seepage pit permitted if public sewer is available within 240 feet.. <br /> i ��--- Size................. Liquld Depth ........... . <br /> PACKAGE TREATMENT .I I SEPTIC TANK f ] . :. <br /> i Capacity i _ . Type -------_--_------ Ma#erigi_ . ...---•• No. Compartments ...........:..... ` <br /> t n ... Prop. Line .... <br /> pistance.to nearest: Well ...............................Founda_ion -•-- <br /> .. Total Length ...... - <br /> LEACHING LINE [ No. of.Lies ........--..•....._...._ Length of each line.................... g .................... <br /> ;;... ;.. .. <br /> l <br /> J <br /> ....Depth Filter Material -.. .. •.. <br /> Bax-.........I ••-- Type Filter Material p <br /> Foundation Property Line/......:.............. <br /> I ' Distance to nearest: Well ...................... ----------.............. <br /> Number - ................ Rock Filled Yes o C N� <br /> � N <br /> F .__. Diameter _....._.... <br /> SEEPAGE PIT <br /> [ } Depth <br /> �— — ........Rock Size <br /> f Water Table Depth ........................ <br /> nearest: Well <br /> .Foundatiort Prop. Lin !................... ' <br /> R7:PAlR ADDITION( Distance to . Date . <br /> / Prev. Sanitation Permit „ ......................... . <br /> Septic Tank {Specify Requirements) ................................ ...:....:.... . . ...... ......._... v <br /> ' ...... <br /> Disposal Field (Specify Requirements) <br /> .. - _• _•._...__..--C9 ........................................ <br /> •____ _•_ __••-_•.._...___..._..-._..----... . ..._.......--................ _� - <br /> • ---------•------------•_____ - - <br /> ----------_--- -------------- <br /> (Draw existing• and required add-i#ion on reverse side) <br /> I hereby certify that 1 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 San Joaquin Local Health,District Home owner or Iitett- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall pot employ any person !n such ntannet <br /> as to become subject to Workman's Compensation law: of Caii!<ornia:' <br /> .:..,. Owner <br /> Signed ; c------•-- <br /> - Title <br /> �. <br /> By __--------------I---------ot- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> DATt: ..7...... <br /> APPLICATION ACCEPTED BY - •........DATE ........................................... <br /> BUILDING PERMIT ISSUED-;-_!-:_!-----------------....----- ......---------- <br /> ADDITIONAL-COMMENTS _.:__-'�:_A: V--------------•--•------•--------- •-•--------- <br /> j ., ............. ...... ........ ........._--• ...............--- <br /> a _ __•......__.__....-...- ....._ <br /> ...._.y----- --------------------------------- _._..LL,- ____.__..._..__.._..__..__.._-•__.._. ...._................__.....-._.-.-.._._................_......__.......- ...._.-...,..._.._ <br /> ...__...... .r................. ...�- _..... _. <br /> r- /, <br /> ---- 23°-_..... ... --------------Date ..... .. -•--..__..._.._..final Inspection by: ' 8/74 3N <br /> - <br /> Eti 13 2!1 1-6E1 iiev. ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br />