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FOR OFFICE USE: l - APPLICATION FOR SANITATION PERMIT ... 3041 ... ................................. i (Complete In Triplicate) 7 Permit No. ........................................................ Dote Issued .7.—.r�. ...-0 ....... .............. 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: .CENSUS TRACE . 7 JOB ADDRESS/LOCATION .._...._.1.42-1.:1.-Zo..--- 8��..........................;..._ .-- ....-----.................. Y.........._..---- _ - -- --- � 6� bbd Owner's Name ....C. p,:-••�'add.J-s.......................................................,....---------.._..---................Phone _.3.....'� ............. Address SaTne ----------------------------------------------------- ........ City _........Lodlb..................................................... .... Contractors Name B1ajakar:d'_s...S.exptic...Tank...................-----------License # ..2.68951------- Phone ...•I�.6- 8•--•- Installation will serve: Residence ®Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other Number of living units:_.-1.......Number of bedrooms - 3. -(..Garbage Grinder ............ Lot Size -----4-.aGr..s..................... Water Supply: Public System and name ..............................................:................ ..............................................Private [� Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Cloy 0,Peat+❑ Sandy Loam o Clay Loam ❑ Hardpans Adobe.Q Fill Material ............. If yes,type ----- --------- ---------- (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,) PACKAGE TREATMENT [ I SEPTIC TANK JC] size........... .'X.5.'.XJ-0.t................ Liquid Depth ......:8.'_'......... --•� Capacity 120-Q.......... Type s. Material.....coy1crate No. Compartments .........2... Jr Distance to nearest; Well ............. 0.'............:-._..Foundation ..........301----- Prop. Line ......30-L.......i LEACHING LINE [ No. of Lines ...... .......... Length-of ach line..... N-0`........ Total Length ..........2IlO.t........ 1-1 'D' Box .... Type Filt�er`Mdferial c....2"..........Depth Filter Material ..............1.9n Distance to nearest:.We-il ...........790. ... Foundation .......5a t-__•--.... Property Line .....--..5f........... SEEPAGE PIT [,JX Depth ---25.'...----- Diameter .............33Wumber ........2................. Rock Filled Yes•# No CIT Water Table Depthg0.!_.......•--------------Rock Size ......2.!t.................. ... G Distance to nearest: Well 100' .................... 0... p. .........1a.'.... ...------•-- Foundation -----�_r].. Pro Line REPAIR/ADDITION(Prev. Sanitation Permlt#�............--•-----•---•...._.. .. Date ..................................) Septic Tank (Specify Requirements) ......1.20.0...9&1-....S&Pt142--- '-o nk..--•------...---••-•----••-•----••-------------..._...--------------..._..-•----.aQ Disposal Field {Specify Requirements) .... QO= Leach Line & (2) P . S. "X2 ' ----- -------------- ....................... ................................._._.................................,............. .........................................................--.................... (Draw 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 of the San Joaquin Local Health District. Helm * 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 - ................... __- 7== Owner By .......,,1 -,6.----......� � ��`' - - ........................... Title ..........C.OntnaC.'liar...................................-_ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY .. ... .. ................... . . ----•---•.._.......... ....................................... DATE ....7..:' . ...... ..... BUILDINGPERMIT ISSUED -----------------------•--...........-----•--........---------.....----- ..................I..............DATE ............................._............. ADDITIONALCOMMENTS ............................................................................ .....................................................:...................,------- ................. ........_.......--•-------------•----••---.---......•--........................ ..................I..... ......................................... .... e ...4............ - ... _ ................ Final Inspection by: .........Date -.. ..... SAN JOAQUIN LOCAL HEALTH DISTRICT E 1-i-13 241.'6R Rev. 5M .7/72 3 M