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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �7 Permit No: --- ------------------ - -------- - - Triplicate)--_. � ��,. . (Complete in.Tripl'scate},,.�,� . I� --------------- Date Issued -`�----------- This Permit Expires 1 Year From Date Issued Appiication is hereby madel�to the San oaquin Local Health District for a permit to construct and install the work herein described. This application is made in ompliance with County Ordinance No. 549 and existing Rules and Regulations: enol i -i s t CENSUS TRACT __7s -- JOB :ADDRESS/LOCATION .� ---X0922---EA --�-a��-------=--- --P----------------- -�-- ----- •---- ------ - , Owner's Name ------ ---------Mr „-T-ho�'tdon----------- Phone -4-65-40-71 '; - ----------- ----------------- Address �X---,�� Sa------- ti - C•,t Stkn---------------------------�y ta{3.._' -_ Bn,tr .... I . Contractor's Name _lkar, t _ - . -� �� :� .--------"--- --- -- ------- _ _---- -- License # 268851 Phone j048 ti Installation will serve: r` ,�Residence ®Apartment House❑.Commercial :QTrailer Court ',Q z I Motel-471 Other ------------------------- ------ i {•,j 1 acre Number of living units:__��__1._ Number of betfroorns _-----------Garbage Grinder _.-_----___ Lot Size ------------- ---- ----------------I• ------------------ tt Sand Loam _______________ Private ® R Water Supply: Public Syste l� and name -----------------------------------t Silt Cla Peat l 1------ ------- Character of soil to a depth�M f 3 feet: Sand [] \- ' ❑ y ❑ ❑� y Q Clay Loam.F : y I 'l } Hardpan F1AdobeT] Fill Material _.!__------ If yes,type ---------------------------- J buildings, etc. must be placed on reverse side.) (Plot plan, showing size o� lot, location of system, in -relation to wells, � ,� NEW INSTALLATION: (No septic tank or-seepage pit permute l"if-public sewer ismailable withpri�20d'feet,) I . - --------------.----------- PACKAGE ---,-----PACKAGE TREATMENT SEPTIC TANK -Size------------- -----` ---:---------- ---- - Liquid Depth Capacity --------------- No. Compartments ------------- ---------- TYpe Ma# Distance to nearest: Well ------------------------ 9eria ---Foundation ---------------------- Prop. Line ---- - I<. No. of Lines ,-1-------------------- Length of ach line'.""---- ---- f---- Total Length ---•--••-----p----•• LEACHING LINE [ „ - i 'D'.Box .-I------- Type Filter Material ----------- 2-u----Dep n _ Depth Filter Material __.__ _-----��--•------------------•---- I i R ^ 71 Distance to nearest: Well -------.--,-5Q'--------Foundation -_-.L :y Property Line --3Q-------------=---- t. i2 ---__-- Diameter _-__3 �:__--• Number _-_ 1--------?----------- Rock Filled Yes Cy No [3SEEPAGE PIT [� Dalpth 11 t Water Table Depth _-______-_-_ -- ' --------------Rock Size ---' - ------- _. 1 '� Distance to nearest: Well ---- QQ' --------------------------Foundation - - -----,----- Prop. Line ----------1Q'------ �M l Date °----------- ---------- ------- ------------------ ------ REPAiRfq�,.lprev. Sanitation Permit# ------------------------------------------ Septic Tank (Specify Requirements)`--_____-------------------------- Disposal _________________________ Di sposal Field (Specify rRequirements) _-.-----l.H.0__---.Leaoh--I--Line--&--2-5'��3 ---------------- - ----- ---------------•------------------------• - ` -------- k. ; r (Draw existing and ed addition will reverse be sdone in accordance with San ,..Joaquin hereby certify that I have prepared this application and t !oaquin 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 "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." r U I OwnerSigned-------- - ---- - - it - ------ By � �------- ----------------• Title - - (If other than owner) v� FOR DEPARTMENT USE ONLY DATE APPLICATION ACCEPTED-,,,,BY _ ------------ ----------- --------------------- -- -------------------------- BUILDING PERM`lT ISSUED .----- ---- ---------------- -------------- -------DATE ----------------------------------= ---------- ADDITIONALCOMMENTS',----------- ----------------------------------------•--------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ 11 I ----- - ---------------------------------------------------------------------- ----------------------- ------------------------------------------------------- - ----------- ----- ----------- w_ _ _ ._ Y : .. ------- -- Final Inspection by: . _- Y Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 1ev_