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FOR OFFICE USE: . APPLICATION FOR SANITATION PERMIT Permit No. 3__z,--5 �, ; - --Z ------------- ---------------- -------------------------- (Complete in Triplicate) -- ------ ----- Date Issued _ --7 -2- 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 described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _.--_ -- N -TRACT' " - �11 �Comstoy_ '_ `- -- JOB)ADDRESS/LOCAT___N _ ------- ---- ---- --------- -------- Phone 93RO Owrier's Name -------------------------------------------------------------------------------- - - Stkn, Address -------,Sam$- --------------------- -------------------------------------------------------------- City ------------------------ -------- --------------------------------------- BlaekardR s License # ---20-951------ Phone 46-3!-7-048--------- , Contractor's Name - ----------------- Installation will serve: Residence ❑ Apartment House❑ Commercial ❑Trailer Court '❑ mobil home 1,Motel ❑Other -------------------------------------------- Number of living units:---. --.-- Number of bedrooms - _- :.Garbage Grinder -- -- '.- Lot Size .-----1_--t�Cz'e----- --------------- Water Supply: PubliclSystem and name ---------------- r. --------- ------Private Character of/soil to a depth of 3 feet: i Sand'❑ Sift❑ Clay OtF� Peat❑ Sandy Loam ❑ Clay Loam El i Hardpan ❑ Adobe ® Fill Material ------------ If yes,type ---------------------------- (Plot!plan, ---_----------------------(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,) j 1 r o Z "x10- .-r--------- Liquid Depth ____ r.r. --------,---. PACKAGE TREATMENT SEPTIC TANKjC] Size------------------- -- 4-------- - ' Capacity _12OOga1 Type --s - Material_- s✓-omdre�teNo. Compartments -----------2..------- t Distance to nearest: Well -100-1--------------------------Foundation ....14°----------- Prop. Line __-_-..----- LEAGHING LINE �] No. of Lines `1-------------------- Length of each line------la©.s------------Notal Length -------------------••------- 1^\ �.`: 9 D' Box 1--..?��Type Filter Material _______--qtr--__ ' De% pth Filter Materitll ________-] "_----------•----••.----•---- A ;. Distance to nearest: Well -- --------- Foundation 20.!----------------- Property Line ------1-00 R.--------- ( , SEEPAGE PIT �] p 2-5t----- Diameter ---36-tt__---- Number ------------ Depth __-___-- -------_----.-- Rock,Filled Yes '® No 0 I ti Water Table Depth -------------90-------- ------ ----_------.Rock Size ----z ------------------------ .Kt Distance to nearei4 Well ----------------1.50#--------------'-Foundation ----1-OAD ti------- Prop.' Line --------50------ Date ---------------------------- REPAIR/ADDITION(Prev. Sanitation Permit# ------- ---------- ) Septic Tank {Specify Requirements) '9 .12-0o---gai.-------------------- ---------------------------------------------------- -•---- e* L: Disposal Field (Specify Requirements) -1.00-1----&---2--5°x36"---p1-t--- --------------------------------------------------------- : , r ---------------- ------------------------------------------ - - -=; - --------------------------- --------------------------- -- -------------- ---- - . -------- ------ (Draw existing and required a dition on reverse side) s Y Y P P T P r �� 1 hereby certify that I have re ared this a plication and that t9i ark will lie done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of-the_San Joaquin Local Healih 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 as to become subject to Workman's Compensation laws of California." ' Signed p f� - wner_ ` Title ------------------ p BY --- -- `------------- (If other than owner) 3z 1 `4O -DA T EPMENT USE ONLY • . APPLICATION ACCEPTED BY ' =� — DATE -:'- } - ---- - ----- --- - -- BUILDING PERMIT ISSUED ----------------------- ------------TDAT�E --------=�------------------ --------- ADDITIONAL COMMS TS ---- r �� ---------------------------------`--- _ -4- --' - ----- ------------------ ------------ ----- -.- � . .�------ . ___ �i -- ------ �., Final Inspection by: --- --------- Date `7 --- ---- -- - - -- € N J AQUIN LOCAL .HEALTH DISTRICT E. H. 9 1-'68 . 5