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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ............. •- -------- i {Complete In Triplicate! Permit No.7(P.- ......................................................... F This Permit Expires 1 Year From Date Issued M M YDate IssuedV-.7, Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 22 84 N, Diz s:tim Rd. Acamn.. JOB ADDRESS/LOCATION ......... ........---........_._....__..._...---... ...............,........... .......CENSUS TRACT Owner's Name ..T.ergy...;3.chwe1gAr4t....---..... ..�j ............................Phone ..3697776................ Same ,.� �� Address --- .._..:..,...........City ............Same............ ................................. .............. Contractor's Name ...r..&.-,0..Se-ptic--_Tank Ser. ..:.....:1`icense 3Q-�7.=21...: Phone . .683933 6c Installation will serve: Residence®Apartment House] Commercial.•❑Traller Court Motel ❑Other ...................... ... of living units------------- Number of bedrooms .........:..Garbage Grinder ............ Lot Size':.:........................................ L Water Supply: Public System and name .. -------= .........._.......:... ........:......:..........:.private ❑ Character of soil to a depth of 3 feet: .Sand O Silt❑_ ..Cloy ❑._ _:P.eat E3,_.-.Sandy Loam.fl Clay Roam [3 Hardpan❑: _Adobe 0. Fill-M tteri-ol If.yes,type_..............-...........-- = . . . t 1 (Plot plan, showing size of lot, location of system in r'elation to\wells, buildings , etc. must be placed on reverse, side `r NEW INSTALLATION: (No septic•tonk or seepage pit .permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f. ] SEPTIC TANK f } �.�. ` size................................................ Liquid Depth .........................- -- ..f-'---v'-.. _ yPMaterial.'....... ....... . ;No. Compartments Capacitye ................. .......� . � I Distance.to nearest; Wel ...................................Foundation ...................... Prop. Line ..........I........... LEACHING LINE [ ] No. of Lines . Length of each line........... ................ Tota! Length ............................ 'D' Box ............ Type .Filter Material ................. Depth .Filter Material ............................--...............� Distance to nearest: Well '....................... Foundation ....... f::..._....._.. Property Line ........................ SEEPAGE PIT [ } Depth ------------------ Diameter ...................Number .... ------- }.. ..... Rock Filled Yes ❑ No (3 Water Table Depth .. :.. _-....Rork Size „ , Disfonce to neaiest:,�Well :..---...Foundation .........:�_.:..... Prop. Line ...............................---•- REPAIR/ADDITION[Prev. Sanitation Permit ...... -___-- ------------- Date ............................ ----... ............ Septic Tank {Specify Requirements). _._:.._...-• ..................... .... ..:_...................................—.---._....--•-•------.:................................... Disposal Field ISPecify Requirements) .0"_�0_ti.gh. 1nem--.60.1_..leach_._and'--7rr7 Well.,..----•............. •- .,-- 48" dia._ 25' deep � ;,* �.� !�� --------------------- -------------------------•----- ------------------------------------ ----------:.....................----•--- ........................................ --------------------------------------------.-.--..........•------- ----------------:--. •........................................................................ .......: JDraw existing and requited addition on reverse side) r —I he�e6y certify•that 1 have prepared this application and than the work will be done In ,accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulatio s of the San Joaquin Local Health,District. Home owner or len- sed agents signature certifies the following: f#I "I-Certify that in.the performance of the work for which this permit is issued, 1 shall not employ any person in such manner as to become subject;fo W rkman'W7e tion laws-of California." Si ned -------------g = f OwnerBy ---- -------------- --- ....--- -- . . ' title _.Owner= :G & C` Septic Tank Ser. of er.than owner) _ -DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY ---. --- - .. ..............•--•--•-•-------------...-------------,..._....... . -..©ATE�....----...�_.�.._ :...' BUILDING' PER1iMIT"ISSUED ------- L_. . .............................__--_-------------- .._----- ................... ADDITIONALCOMMENTS ------------- .-----------••-------...-------•------ ...---------------....--. . -•--•------------------...----...._.._.. ...............•-- ----------------------------------------------------.....---------------_--------- ---------- ......... -------------------------- ..._...-----------..._.._.....----..... ` .. --------------------------------------------- --------- ------------------------ j ----------- .. . .................__.._..---..............._.y; :...._... --------- ............ ;_ Final Inspection by: ---------- --•-'__-•_ ...._ . .. ' Date EH J 3 21t 1-68 Rev. AN JOAQUIN LOCAL HEALTH DISTRICT 8�7& 3M