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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------- ------------- ------------------ -- (Complete in Triplicate) Date Issued �- This Permit Expires ] Year From Date issued I . _ _____ ___ _'-----_------------------------------I application all the made to the San cmcDistrict rmit to construct and t Application is hereby yOrdnanee No. 549 and existing Rules Regulations- d�sc3e �h ap lication is made in with Count �,Appx. 1QbD` So. of Harney Lane on the CENSUS TRACT --------------------- ----- JOB ADDRESS/LOCATi _Eas-t---5-ide.---af- -Gu-r-r-y---Ro-&d---Lo-d-i , Jim- it i n.c h e 11= Phone ------------------------------------ Owner's Name -------------'------------------------------------- --------------- -------------------= ---- - ,: --------. City -----oto-ckton------ --------=------------ Address -----------------9�� r_alise_ Contractor's Name ---°Ro-to-�Roote_r---Sew°-x---S _.License #i5-q2��- -------- Phone .��-�-2_b16___---- Installation will serve: Residence ®Apartment Nouse'❑ Commercial:❑Trailer Court i❑ ,/ Motel ❑Other -------------------------------------------- ------ ------ ------ ------ ------ ------ y t - - -------- Number of living units: . -----:-- Number of bedrooms -----3-----Garbage Grinder no--- Lot Size _-. ---x--- s --------Private 21 ----------------- Character of soil tola desth of and name -------------- -- .. pp y r Peat❑ Sandy Loam R] Clay Loam ❑ p '3.feet: Sand'❑ Silt❑ ClaY ❑ n ._ If yes, type - Hardpan ❑ Adobe '❑ Fill Material _.-_-- --- ----------------------- p 7" buildings, etc. must be placed on reverse side.) \ (Plot plan, showing size of to t Vocation'of system in relation to wells, NEW INSTALLATION: (No septic taAk or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT .j`] SEPTI [ ] Size y 1 Liquid Depth ---+21 ---------- C TANK Ca aci 1200 ----- Type Prefab. Material__c-on c---e t_� No. Compartments G p , tY;� ' ---.Pro Line ----`tet I j t ``«s t----------- -------Foundation - �U p d Distance-to..neares#:_W1 - 0 1 Total Length 240 -------- LEACHING of Lines, -' Length of each line-__.____----II� ---- 9 f LEACHING LINE [ ] ;m _; ------ ` p' `Box _ - T pe Filter Mafierial _L�"ro-ok-Depth F;Iter;Material --_--i�3'' Y a �nearest _-- - -v---"- r Property Line. ----------------- ------ 6W Distance ,to Well ----- -- Foundation s C] No SEEPAGE PIT DepthDiameter ---------------- -Number`------------- - -- ❑ Rock Filled p ------------------------------------------------- Rock Size ------- -- Water Table Deth ' Distance°to nearest: Wel1�.� ,------- --------Foundation _------ Prop. Line ---------------------- Is ` Date -------------------------- -------) REPAIR/ADDITION,(Prev. Sarntation erm� --------------- Septic Tank (Specify RequirementW---------------------------------------------------------- k Disposal Field (Specify Requirements) -------------------------------------------- - -- - - 1 —---------=------------------------------------- - ----- - --- - ------------------ [ _ ___ ____i________________________._____ ---_--_-_--.--_----------__--.-----_-_---__---_-_________.______________.___.____________. -3 5•'lbraw 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 cen- of_the-SanTJoaquin.Local;Health District. Home owner or III sed agents signature certifies the following: permit is "I certify that in the performance of the work for which this 'Issued, I shall not employ any person. in such manner as to become subject to Workman's Compensation laws of California." ----------------------------- Owner Signed -- -------- ------- ------- -�---- ------- ------- --------- , _ ------- ------- -------- - Title ------ Own ---------------------------- r[ other than owner) F01t DEPAit USE ONLY k DATE l ---------- - M APPLICATION ACCEPTED BY. :'. --- DATE -.._._- � BUILDING PERMIT ISSUED ---------------------- - ------------------- - ---------------- -----------} ADDITIONAL COMMENTS ------------------------ --------------------`--- -- t� ______________________________________________ ______---------.----_--_--_-_ _ ----_-_------------.--------_._---_---------_---_-----_-_.--_-._-_--__-_--_-----_--_-- ..•. __- - !�c Date - ---- C - --------------------- - - - ----------------------- -- f�t.0 ---------------------- --------- Final Inspection by: ._____ _____ - ��' - SAN_.IOAQUINLOCAL HEALTH D1�5TR1CT y E. H. 9 1-'68 Rev. 5M