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FOR OFFICE USE; <br /> I 'PLICATION FOR SANITATION PE> T 3 <br /> ....................... Permit No.7.-....._ al <br /> p- <br /> (Complete in l'riplicate) <br /> F -- This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> F described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations.- <br /> JOB <br /> egulations:JOB ADDRESS/LOCATION .._......14 1-a'.-LTo.....83....----•....................•--...------ ..............._........CENSUS TRACT . ..Y.7_.-••-••-...... <br /> Owner's Name .....C..... � c�c . ----------•-------•-•.................................t..---- ...----....... Phone '� �. ��b .......... 4 <br /> Address ....._�a E..... ......................... ...... City Lodit............. --••---•---••----•-•-...................... <br /> Contractor's Name 31acka r.d'.s...S.e1D-td e-..�'�r„k-_-..---------_-------•---.License # -.22-689-51_-_ Phone ...•1�6-�,.�Q1�.g•-... k <br /> Installation will serve: Residence ®Apartment House Commercial []Trailer Court 0 <br /> Motel ❑Other ................ .......I.................... <br /> Number of living units:---1...... Number of bedrooms ...7.1..Garbage Grinder ............ Lot Size .....Jk..a r s--------------------- <br /> Water Supply: Public System and name ----- •-•--••--------- ..................... --•--.....------•.................................................Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat'o Sandy (Loam ❑ Gay Loam ❑ <br /> Hardpania Adobe ❑ Fill Material ...--------- If yes,type -_-_-_____--_- <br /> (Plot plan, showing size of lot, 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 200 feet,) <br /> F <br /> PACKAGE TREATMENT { } SEPTIC TANK Size-.-___.... 0'......_.__ <br /> �} .�.-----�---..�.. ------ --- Liquid Depth ......48.'_'. <br /> Capacity 120-Q........ Type sq............... Moterial...zonarate No. Compartments .........2...........s <br /> F Distance to nearest: Well ' *_-..- I� <br /> ..-..--------��Q-•--•-----•-------..Foundation -•--•-----�Q-. Prop. Line ------3t3*--._..._.� <br /> LEACHING LINE {J No. of Lines _.....___._ .......... Length of each line.____.104-'............. Total Length ..........2= ........ <br /> 'D' Box ----1----- Type Filter Material ---_2".........Depth Filter Material ...----------1-9!........................Z <br /> Distance to nearest: Well ...........29-1...... Foundation Property Line ..._.._. ...... <br /> SEEPAGE PIT (JX Depth ._, ........... Diameter .............3.3Klumber .........2................. Rock Filled Yes 1D No <br /> Water Table Depth ' Rock Size <br /> Distance to nearest: Well 1.00..*............................. Foundation 150........ Prop. Line .........3.Q...... <br /> FREPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................) <br /> Septic Tank (Specify Requirements} ....--1-20.0---�'�1-.--•S�p���--?'�.�k-----------••----...--•------------------------..............-................. <br /> F- Disposal Field (Specify Requirements) ....2001 Leach Line' & (2)_Pits _...3.3'�X25....-- � <br /> ............................­.­-------------------­ <br /> ................I.............I---------------- <br /> ................ ---------*--------------------------------- <br /> - --•....................---------..-....--------------------•-••------•-----------••----......-...............111.1---•----........----• 1111.. .--•-••-•----•.........•-•---..-... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordancewith San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home ovmer or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed --- == <br /> _ ---•- ---•----•--..... Owner <br /> FBy '': ,, :.:�..-1111 Title ------- C-an'trj°ct r----------------------- , <br /> (lf other than owner) <br /> I <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED : ,--------•-- DATE..... .. : --••---•-•-••- <br /> BUILDINGPERMIT ISSUED ... ................... ...... ................................................................................. ........................ ------------ ............................... <br /> ----------•-._................. <br /> - ----------------------------------------•---..•_._------.......... --•--•---...-•----....------------ •-•-•--------------------•--•-•-•--•---------------..:_...........R...------•---•--... <br /> ------------1 .•-•------------- 1.111._.. _ ?° ..._.: ...---------•---•------•---....----- j <br /> _1111 _ _ <br /> Final Inspection by; .. . .. ;:;; .�w • �y ..... ;._._:. <br /> -----•------••--•------•-•..........................Date . .. .... ....: . <br /> r SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> u l.3 24 , .,n n--- e,., /ten 7 v <br />