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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT <br /> ...................1....---•----------•------.._...._._.. Permit No. ...7.;�..��__-��-� <br /> (Complete In Triplicate) y <br /> issued <br /> T' '•• _..:.'-"_`.—This Permlf Ezplres 1 Yeo-irFid-iK.Date l'siued'•""' <br /> 1 <br /> fApplication is hereby made to*'the San=JodgUin•L'ocal Nealfh,District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549. and existing Rules and Regulations: <br /> _` : D ! /LOCATiO ---- jj..._...... ....��............CENSUS TRACT ....................--- <br /> q'�•............. ............ _.,.. TRACT <br /> J08• Aka't� 5S �- `---� <br /> y one <br /> Owner's Name .. r6?:rU . -� fJ .PrP ,. ._....... :.................................... <br /> Ph � V <br /> Address ._' .7 :. D 3 ../S .iv l�...................... City . .,W ...................... <br /> ... ... ._ it <br /> , <br /> Contractor's Name .:.............' ......License cry... ............. Phone <br /> Installation wilt erve: Res dente_ [ Apartment Houseo Commercioi`oTrailer Court 0 <br /> A i � <br /> k I, Motel p Other <br /> k y - <br /> 1.3 .Garbage Grinder � .::.. Lot Size � ............................ <br /> Number of living units:__._"a Nunit;er�,of bedrooms ____.. ------• •-••••--•--•--•• <br /> Water Supply:;Public System and.name:: ................ rive <br /> ..............-••.................................�.....•--• Private <br /> Character of soil to a depth of 3 feet:'� Sand�b Silt El Cloy Q Peat❑ Sandy foo f Clay Loam ❑ <br /> € Hardpan 0 Adlbe❑ Fill Material ............ If yes,,type . <br /> a ` e fi t � � � <br /> {Plot plan; showing size of lot, location ,of!system ink relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tdnk or seepage.pit permitted if public sewer is available within 200 feet,) <br /> Liquid De th-- :- '.•- <br /> PACKAGE hTREAThAENT [ SEPTIC-TANX-1,]. � Size._ .;0...;t< ..; R p <br /> i 1 ' Capacity . - Typr jQ c'o Material---------------------- NoF Compartments .......a_. ..... <br /> S '�"�* <br /> s :. s ........... <br /> ` Distance to nearest:`,'Welf " = <br /> � � ::":":"�"`�._.Foundatian �C3..�........... Prop. Line .�. r O <br /> LEACHING LWE ( ] No. of Lines .-... :__!e»,.___-- Length of each brie-.:-.f-Z9-------...--•--- Total length ....: •lGs--•--...... Ul <br /> k r t i r1 <br /> .. Tyo-Filter. Material - /O_t� e th .Filter Material <br /> D Box ..J...-- - - - p �. -aF l,/-•.....................1-•---.... <br /> . r a � S .-..... <br /> Distance to nearest:�Wefl�� --`- ..-----._ Foundation ...:......... . Property Line ...�7......_.._...... {� <br /> SEEPAGE PIT ( 1 Depth -------------------• Diameter ......--........ Number ......................... Rock Filled Yes [3 No 0 . <br /> Water Table Depth ......- -... ..._Rock Size ..•.......................... <br /> o <br /> Distance to nearest: Well ---------------------------- -=-..Foundation .........-._-._.....*.Prop Line .--•---..........., <br /> t - 7 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# � ` " u^ ° -- -.••.!Date _----•-------------- ......... <br /> I <br /> Septic Tank (Specify]Requirements) --- --------------- ................... ------•---- "._._. ........... ........... <br /> Septic <br /> Disposal Field (Specify Requirements) --•--- i *� � I <br /> i ------------- ------------------------------ ------------- --------- ------------------------------------- <br /> ------------------ <br /> I1 .-��. �{-_...... ................................................. <br /> -� (Draw existing and required.addition on reverse side) <br /> Ishereby certify that Iihave 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 focal Healtl�_District. Home owner or Iicen- <br /> sed ogenti signature certifie's1hefollowing: ; <br /> "I certify that in the performo:nnce`'of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to betaine sable o rk"- 's^ ompensation laws of California." <br /> Signed i . �`.. Owner <br /> - _..... <br /> g <br /> BY ------------------ Jitle --------- ------ ..:... <br /> " <br /> i (if other than owner) <br /> l FOR DEPARTMENT USE ONLY <br /> APPLICATIQN ACCEPTED BY _.. .. DATE .....,. <br /> f <br /> ADDITIONAL COMMENTS ----------•---------•------------------._-.---.------•-•----•-----.._........------. .._ <br /> •---------. DATE - <br /> . . ... .. <br /> ..._ _------------ <br /> r <br /> ------.--- ----------- - ---------- .-•--- -------•------------------ :: ...__._. <br /> _ _ <br /> . -- --- <br /> Final inspection by: .. Date <br /> EH 13 2L 1-68 5M,� SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />