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LEACHING LINE .1 <br /> <br />SEEPAGE PIT I I <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires 1 Year From Date Issued <br />Permit No. <br />Dote Issued 7 -1 -3" 7V <br />FOR OFFICE USE: <br />............. .......... ... <br />Application is hereby made-to the San Joaquin Likol Health District for a permit to construct and install the work herein <br />described. This application is mode in compliance with`tonty:OrdinanCi No. <br />' <br /> 549 and existing Rules and Regulations: <br />ir ; c <br />JOB ADDRESS/LOCATION :a lerdg , Ale 470/5" /7--;-7 a4,407 e CENSUS TRACt <br />Owner's Name' 72,07-'171• .49‘,X./.7.,;(--;ai ' •$, Phone <br />Address••,C•) 4,72 -Er — City . . • <br />Controcter's Name.A%!...0 —.....0.1710.,.."•:............... ............ :.. .License # ‘2...1/........g..f..' Phoneli.4.-C;24i , <br />Installation will serve: Residence gc Apartment House d CornmercialpTrailer Court 0 <br />. Motel' D Other . • <br />Number of living units. / Number of bedrooms ..1,-- Garbage Grinder "fvf.'1? Lot Size <br /> Private <br />Clay Loam 0 <br />(Plot plan, showing size of lot, locotion.of.system.in relation to wells, buildings, etc. must be placed on reverse s e. <br />NEW INSTALLATION:- • (No <br />PACKAGE TREATMENT' <br />.. <br />Length of, <br />i <br /> each line" _ <br />- ! Total Length <br />4 1 4 <br />'D' Box •_. Type Filter 'Material ..... '. .. ....... Depth Filter Material <br />'I o <br />Distance to nearest: Well . Foundation. `` .• . ' Property Line ' <br />Depth ...... ... . .. . ....... Diameter t Number ...... ....... ...... ......... Rock Filled Yes 0 <br />1. ..--•-t .1 4- <br />Watr Table Depth • Rock Size 1, <br />,i, .-. „...j Distance to nearest: Well <br />REPAIR/ADDITION (Prey. Permit # P ti i on Santae : , . . , ,, Date ....„ . ..r: ....... ...:..........—......) . /14 . <br /> <br />l eptic Tank (Specify Requirements) i • <br />Disposal Field (Specify Requirements) / 7..,,... ... ., ......... ........... ,. <br />_ <br />t iip.:,-,:• , <br />(Draw existing and required addition-on reverse-side) i <br /> <br />i hereby certify that I have prepared this application and that the work will be done in accordance- with San Joaquin, <br />County Ordinances, State Lisws, and Rules and Regulations of thits San :Joaquin Local Health District. Home owner or licen- <br />sed agents signature certifies'', the following: 4 <br />t , . <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 />:i <br />Signed Owner <br />.. <br />(If oth t.' '- DEPARTMENT USE ONLY <br />A , . DATE..,..' 21 <br />: DATE <br />Water Supply: Public System and name <br />Character of soil to a depth of 3 feet: Sand 0 Silt 0 Cloy 0 Peat O./ Sandy Loam 0 <br />Hardpan Adobe 0 Fill Material. If yes, type ....... <br />Capacity I 1, Type' <br />Distance to nearest: Well • <br />No. of lines • <br />septic tank or seepage pit <br />SEPTIC TANK j „ <br /> Material <br />‘, <br />permitted if public sewer is available within 200 feet,) <br /> <br />Sizel Liquid Depth ........ ....... <br />No. Compartments .— <br /> <br />, Foundation Prop. Une <br />No <br />Foundation !nip. 1,ine <br />- <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS ' <br />a. 4. <br />Final Inspection by: Date <br />F 14 13 24 1.-An Rev. 5M <br />SAN JOAQUIN LOCAL HEALTH ' DISTRICT <br />- <br />7/72