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FOR OFFICE USE: APPLICATION FOR,.SANITATION PERMIT Permit No: .- _- 9° -------------------- _ (Complete in Triplicate) -- ' Date Issued -. -------- -- -- This Permit Expires 1 Year From Date Issue---------------- , ------ :--- rein Application is hereby mis the made compliance withal County alth District Ordinance permit and existing Rules tand Regulations.l the work described. This application _ - - ------------- - CENSUS TRACT ` - JOB I.ADDRESS/LOCATION .---.333.7- C1ark__Dr'. ------------- 464-8887 ---------- i Phone --------------- --- ---- ----=- ---------- Own`er's Name - HEi'-I'1-1n---B-ees-1Y------------------- - -----= -------- Cit Stlkn-� - Address -------sante- I----- Y ' License # --26-8-g51----- 'Phone 46-3-7048-- ------------------ Contractor's Name _$laoka.xd 9-S------------------ ------------ ! j Installation will serve: Residence�_Apartment House❑ Commercial_❑Trailer Court ❑ - � Motel ❑Other --------------------------------------------- { # Size ___ ___A�� -- ------- Number of l v ng units:.1-.-_--_ Number of bedrooms _--_2-_____Garbage Grinder ---------I- _ Log- .-------- t ❑ Y Private Water Supply: Public System and name ------------------------------- - ---- ----------------------- peat Sand� Loam.❑ Clay Loam E]and'❑ Silt❑ Clay ❑ i Character of soil to a depth of 3 feet: S ; ' Hardpan ❑ Adobe'�M Fill Material ------------ If yes, type ---------------- t r , , (Plot plan, showing size of lot, location of system in relat onto wells, buildings, etc. must be placed on reverse `side.) W r public sewer is available within 200 feet,) ; q� . NEW INSTALLATION: (No septic tank or seepage pit permitted'N�p j PACKAGE TREATMENT ] ] SEPTIC TANK'[] Size__ _t_X5_'_ -------- •' Liquid Depth ._ 8-'-+........ , - V ----- Material-a-ement--L- No. Compartments .-----_---'•-•--;-- V Capacity120Q_--gal-.TYpe �4� t r, _--Foundation s-------------- Prop.Line __5--�---------- Distance to nearest: Well _ -�00-t- No. of Lines '-==-___-- Length-of•-each line---: QQ- -r Mater alal Length 1QD-*= = I LEACHING LINE [ ti s ,� D' Box - YP ----Depth Filte ; 9 0 I - - - - Dis#ante to nearest: Well ------ Foundation ---------- Property? Line. --••-- } :..0.. SEEPY Depth r " --___--- Rock Fillbd Yes_ ® No AGE PIT ] p - -.25 --- --- Diameter ------- Rock . Number Z Water Table Depth _ ------}O�-c-- ------------------------------ Rock Size 2'� _ Distance to nearest: Well ------f,- - iFoundaiion ----- Qt------- Prop. Line -------- �r-•--- --- ) • t `�- "f' � Date ---------------- L --•--------• � . ---------------- REPAIR/ADDITION(Prev. Sanitation Permit __------ "' mo - i ----------- ---- - -v . ; Septic Tank (Specify,Requirements} _.___ 2(}�--�;$ '* ...... { A ! Disposal Field (Specify Requirements) ___1QQ-___Le3Ch._Ulla-_-&- 2 ... r ' `E11! --------'-l`----------- ; required _ -; , ---=----- -------- -------- ------ -------------------------------- —yI ) ' -:'--------------------------------------------------------------------- ---------=---------------------- --------------------------- ----------------_-- -I- _. _-ronrevarse side)existing arid additioi ; ' ' a I hereby certify that I hove 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 Ucen- I sed agents signature certifies the following: arson in such manner "1 certify that in the performance of the work for which this permit is issued, i shall not employ any p. as to become subject to Workman's Compensation laws of California."; Owner -� Signed -------------- - 1 `* ------- ----- --- ` Title.' Q Y (If other than owner) FOR DEPARTMENT USE ONLY �____-___a____._.__ APPLICATION ACCEPTED BY ._fir - ,rcur-------------------------------------------- DATE ----- - - ---- - - DATE 3 BUILDING PERMIT ISSUED __ - ��,---- ADDITIONAL COMMENTS __��'t,_'7 ---l�--- -_--- o sa'°c r- --�--- ------------------------------------------ j --------------------------------------------------- ------------------------------------ ---------------------------- --------------------------------- ------------------------------------------------- i -------------- ----------------------------- _ a�' .d.. -- ---------------------=------- CAL HEALTH DISTRICTDate 7 Final Inspection by; --------'ter-'--�- --------- ----------------------��-.i-.-�----- - - i SAN JOAQUIN LO, E. H. 9 1-'68 Rev. 5M - -