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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT / <br /> fCetnpletein Triplicate) Permit No. 7rv.:.5.._..-.. <br /> -»............................................ This f amb Expires I Year From Date Issued Date Issued <br /> Application is is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This oppiicotion Is mode in compliance with County Ordinance N . 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ... ......�./!` ...... Odom .. I CEWSLIS TRACT ................... <br /> Owner's Name .-.1.`. . �? ........................... ��_......................................................Phone . 1�;W T <br /> .......... <br /> Address ' -10d0A3W1Ad!OW.Wy ................. . ......... ... <br /> Contractor's NameW.............................................. ...License f .................... Phone ....................... <br /> Installation will serve: Residence❑Apartment Hausee Commercial❑Troller Court ❑ <br /> Motel NOther...'.I> 7S ..............Number of living units: �....... Number of bedrooms ..9.......Garbage Grinder ...:........ Lot Size •._l` . <br /> :V��4�R-e <br /> ....... .. ....................... <br /> Water Supply: Public System and name rlvcftxt <br /> Character of soil too depth of 3 feet: Sand❑ Silt❑ Cloy, " Peat❑ Sondy Loam Q Clay Loam❑ <br /> Hardpan ❑ Adobe 0 Fill Material ............if yes,type............... ............ r <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be plated on reverse side.lp <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) (s <br /> PACKAGE TREATMENT SEPTIC TANK r <br /> 17 ` Size...................��..�..'...r�..r.................. Liquid Depth ..................... <br /> . .. <br /> Capacity llzo ..._ Type ........ Moterial..`.Vf-. ^?^k.... No. Compartments .-rt�..............7 . <br /> O� go' LjT <br /> Distance to nenayr�est: Well .... .f .:'r...................Foundation ...�................. Prop. Line...!! ..�...... <br /> LEACHING LINE fk( No. of Lines fA-.....I.......... Length of each line.....I��........... Total Length ... 007*..........im �. <br /> 7� 'D' Box Type Flhar Moterials.Oeptr OF"......... property Line ... p <br /> .. .._� h. ... Flltm Material ....Lcl ... <br /> .... ............................lQ <br /> "�''�[ Distance to nearest: Well .. �.+.......... Foundation IO....... �fi........... <br /> SEEPAGE PIT uI Depth clV -....... Diameter i& ........ Number .........A........_...._. Rock Filled Yee No Q'f� <br /> I si <br /> Water Table Depth .....9 .........................».......RodsSize .-s�:'.�............. <br /> -.. ... <br /> Distance to nearest: Well .......................................Foundation ......-..... ..... Prop. Litre ...............»..... j <br /> REPAIR/ADDITION(Prev. Sanitation Permit# •...-.................-................... Date ..............._................. <br /> I <br /> SepticTank (Specify Requirements) ............................................................................-.......................................................... t <br /> Disposal Field (Specify Requirements) <br /> ..........................................................................-......................................................................................................................... <br /> .................-.............................................................-..........................--_.............. .-..............................»....-..........I....... <br /> . <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 accordance with San Joaquin i <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcen- a <br /> sed agents signature certifies the following: <br /> N 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 .. _...............=..... ... . ..(--o------...-...---------------------............. Owner <br /> By .,kr. '✓ }.............................................. Title ........................... _. <br /> other than owner) <br /> FOR DEPARTMENT USE ONLY �® <br /> APPLICATION ACCEPTED BY .. _ . . .. . .. .... - _.................... - ........... DATE _. ,- _.-�- IEa...........: <br /> BUILDING PERMIT ISSUED _. .............. ................................--------- ...........................---.......DATE . ----------- ......... <br /> ADDITIONALCOMMENTS --------.._.........................................__........._............................. ........ <br /> __.. .. ............................................................ .-........... ----- ._....... - .................._._ — <br /> _.. ................................. <br /> .............................................. .. ....... ....... . <br /> final Inspection byr ......... �.. ..... <br /> Date ... - ' 7..:'..:::::::.:::::::. <br /> Elf 13 24 1-68 FLrw. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3H <br />