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FOR OFFICE USE: APPLICATIOW FOV-SANITATION PERMIT I Y - --------------------7 ------ `. ,r Triplicate) - Permit No 1 -_ . . i QComplet&1n � _1� �r_ -!� �( Date Issued 1 f� Y ;"� !— This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work' herein i described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: , � -------------- -CENSUS----�---� MI �N I JOB.ADDRESS/LOCATION _4109 Hd' �- � TRACT I tf Owner's Name -.Jo-_S" ,�v_�.Er ---------------------- - '__Phone.: .� _==. Y ; Address -37--- -- --------------- ----------------I Cit-- - III---------------------------- Contractor's Name _Bla"ckard's "Septic Tank Ca_.__-_-_ ? 63 '7-048" -- ----.License # ---�---.��--�5�------ Phone " Installation will serve: Residence ® Apartment House'❑ Commercial ❑Trailer Court}i❑\ Motel ❑ Other -------------------- - - - ----- -------- Number of living units:--I--------- Number of bedrooms ___ -- -- , $� X1 I a _____ abo - ------- Lot ` ____ _____ _____________t_ __""---- 91 Water Supply: Public System and name -------------- - --------- --------�g-------------- * -----------------------------------k-" - ---Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Gay .❑ Peat ❑ Sandy Loam -❑ Clay Lr am:❑ + Hardpan ❑ Adobe ] FiOMaterial ------------ if yes, type -------------- ------ i [Plot}plan, showing size of lot, location of system in relation-tomells, buildings, .etc. must be placed�on reverse side.) NEW INSTALLATION: (No septic tank or seepage,,pit permitted if blit sewer is available within 200 feet,) t O PACKAGE TREATMENT [ ] SEPTIC TANK ] ��Size----5_*_ i ---_.__ Liquid Depth �� �b--X•10---------------- q p� 60-----------.----- I Capacity _-1.6(}0_._----- Type -1!=.59.E "--- Material_CO 1Cx'ete No. Compartments .2_"".""_--:-_.":---- Distance to nearest: Well ____50-#_____a" ----------------Foundation -1-0_$_ti.-____<___ Prop.11-ine __24}_............. LEACHING LINE 6rj No. of Lines ----____ Length of each lin --_ iota h-L'engthl ---- 'D' __ D' Box - -------- Type Filter Material 2";-------------Depth Filter Material ------- � - ^==., .- -------- .,__ . ^x.. . Distance to nearest:.Wel.l„-__ _____ 0_f_______'-Foundat.ipn„�_-_2Q�__;:____ :_Property_Line TO” SEEPAGE PIT Depth -------- Diameter ----36!! ___ Number _2------------------------ Rock Filled Yes [R No - Water Table Depth Q e -------------=--------Rock Size ---------2.lt-------------------- Distance to nearest: Well ---100--'---------------------------Foundation -6D-°-----. Prop. ,Line ...1��-=-".:---- REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------------------\--- -- Date --------------------.-------------I j 1.600 a1 °f r� Septic Tank (Specify Requirements) #--------------- - - -------�--- -�------------=---------------- -------------I----------:-------------- ----- ----------=-:-•---- Disposal Field (Specify Requirements) -1 -Q-°---L�'a_ch__Lix1 ---s4� _2--------36_'---X2 -'---Pits-•------- ------------------------------ y �p } /, -------------------- ------------------------------ - ----------------------------------------------- ------------------------------------------------------------ (Draw existing and required addition on.reverse side) I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner r as to became subject to Workman's Compensation laws of California." Signed ------- - ------------------ -------- i----------------------•----------------- Owner _Y , Bill Blackard cpntractor BY --------------- - -- l - - Title - - - (if other than owner) ( I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --- - ---- - ---------- -- -- -- --- ------------ DATE t"Z' - ; BUILDING PERMIT ISSUED ---------------------------- ----- I---------DATE .------ -- 4------------------ ----------- ----------------------- -----•-----------------.--- -- - i � � it . ADDITIONAL COMMENTS - -------- ----- ---- ------ --------- 9 f - - j / s ----------------- - ------------- --- ---------------------------•-- 7"" -- -- ----- ------- - --------------- --------------------------------------- ----- ------ ----- --------- -------------------------- r a ------- = ---------------------- -n- -------------------- - ) Final,Inspection bY: ---- --------------------- ----------------------------------- ------- - Dat `� Y -- ----- Final ,. "1f''fOAQUIN�L0cAL 'H)=AALTH DISTRICT v E. H. 9 1-'68 Rev. 5M �I