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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ........ lComplete in Triplicate) Permit No, ..7.... ....... 5 ]. /. . .._ Date issued -ia:1.7C { This Permit Expires 1 Year From Date Issued t Application is hereby made to the San Joaquin local Health District for a permit to construct and install the' work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations:/ JOB ADDRESS/LOCATION .... .75,9... $ -.Cabe.._Rd.................... ^:•,. '..->..CENSLlS TRACT ............_._. .�._ Owner's Name ..Johnsons y.,c` � Phone .8 �LI Address .. P, --C38�7 " i3d� ---•-- . -t.. �u �' t!~ `Tracy u � ..n ,. Y .. ..... .......... i Contractor's Name _. -P-ay -L.eS._-_ septic- Tan °-�c...s� eiry26�?37b5»& 98 _ _..L�cense # -.- Phone __......_..._ .2 ......... Installation will serve: ..: 'Residence Apartme- W$Ge❑ Commercial _]Troller Court ❑ � _ . a Motet Other`. t - ,... _�. -------------------- V living units:..).__.... Number of bedrooms .4 arbage Grind'er�:,:ye8. Lot Number ofvn sill i �. _ .. I Water Supply:•Pub]ic System and name ._.. .... ... x ... .-: .. --;.- - ._---: --- ---------------. �-r •------- --.Private Character of sail t depth of 3 feet: Sand El Silt El Clay El pat El Sandy Loom`0 Clay Loam [] ` Hardpan ❑ '*dobe E0 Fill Materia! -.......... If yes,type .......... . .............. (Plot plan`, showing size of lot, location of system in relation to wells, .buildings, etc. must be placed on reverse side. NEW INSTALLATION:- �(No septic tank or seepage pit permitted if,public sewer is available within 200 feet,) PACKAGE TREATMENT [k�:'3-,SEPTIC TAN Size � K f )� _,..��• �.:._. Liquid Depth --- , 1 Y ---- Type --------- Material-.......... No. Compartments ...................... istance to nearest: Wel! Prop.1,Line ................. .... LEACHING LINEz<(:d N _i Lines 1. l�.OE +�'` l 40t 4 ..... Length of each line ......... .... .........x,,Totol Length.. ..._._._...I--..__......... ; D�Erx .no... , Type Filter Material Y'qq)' ._._-:---Depth Filter Material -J.....I............................ Distance to nea-rest-Well . Foundation lOt Property Line t ... If C— C] ] Depth , 40.— i. ��1 Diameter "Number ,r _ .-- Rock'�Filled Yes [ No 1'✓✓ Water Table Depth `?.._ r........ �...... .......... ock Size - �.:.. Prev. SDistance to nearest: Well _°�---75 :.:-10 .4> --•,_Foundation ,.1.d�...._...... Prop. �ine .... .............. REPAIR/ADpITION an ( itotion,Perm•it-t#. ,..x_.- `.:,...._. .' 1�Date _.. ------------------------------ i I Septic:Tank (S ecif Re uirements r ..s. . .. ,-�.l Dis osaf Field (Sp city R�quiremen�( ..adding �f leacY�:and_-one - �o existing sy ;t m f -I. _ �.. . x - # _ t ; (Draw existing and required addition on reverse side. ] I hereby certify that 1 ave prepared this application and that the work will be done in accordance with San Joaquin . � Laws, [a County OrdinaEnces,r5tate and Rufes nted Regulations of the an Joaquin local Health District. Home owner or titan- sed agents;signature certifies='the following: . i "I certify that'in the performance of the work for which this permit is issued, I shall not employ any person in such manner I + as to becomesubject to Worl�non's Compens ion laws of California. J[ Signed .- ---7.---._. caner By :� . . :.. .. Title :CONTRAMR...... ........ a other an oWnerl erry -.0'V.... thdh- V••- `> P' FOR DEP. RTMENT USE ONLY APPLICATION ACCEPTED - . .... . . . BY. .... . - i. . . . .. ..... . ........... - - -=- --.>..,. .•,,.4.,�.+-..---.. DATE ..... .. .lQ.. ...�f.. .__.._..._.. BUILDING PERMIT ISSUED E... ..........._._:. ,.._.r.+.:.....DAT£ .. ..... ......... i ADDITIONAL COMMENTS . ................. .. i 4 J' ' - .................. ---- .......... .:...... ......... �... . l.. _ - ---------------- .--------- . ` k _....---..Date o� ..._..z. _- Final Inspection by: .. {.. = ---------------------------------------- -- J ........... SAN JOAQUIN LOCAL :HEALTH DISTRICT 3r2T+ }-48 Rev�_511d _ 7172 3-H t