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} FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ......................................................... Permit No. ...2A 1S. Kemplete.in Triplicate) ......----•-•...................... - Date Issued 7a�". .:? ...... This Permit Expires 1 Year From Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made incompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION:_.....173 ::.Fk9.xz1.. ?xa.........:............................................CENSUS TRACT ............. Owner's Name .J1M.XaUf_f�raaash-.............---.............. ........................................ ................. Phone ..... .............................. C Address .-.2 j - --�+I. Hammer Ln, •--- ....., City ....... tkla....._....-•---•--•.......... Contractor's Name Blackard'' ----•_•._._•.....:........License # _.Z6� -- i••••• Phone ..__................ . .s....Se.....� �- Installation will serve: Residence Z] Apartment House❑ Commercial:❑Trailer Court Motel ❑Other --------------------- - ----------• ...... ( Number of living units:.... Number of bedrooms ....4......C6rbage Grinder ............ Lot,Size ....____-_-1-3.4-!.X.j-15o t••-- Water Supply: Public System and name .....4................X"aumity-------•------•------•------..•_ -------.-----:.......................Private ❑ Character of soil to a depth of 3 feet: Sand❑ .Silt❑ Clay ❑ ,.'.Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ® Fill Material'....__._.. If yes,type .............................. (Plot plan, showing size of lot, location of system in relation to wells, buildinl2s, etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) R PACKAGE TREATMENT [ SEPTI /�T/A�NKt3q Size........__b:'_K7_.x_9..................... Liquid Depth ...:...-----�J��"....... O l Capacity ...------ .....- Type 162=E.Material-----aoncs'P_tENo. Compartments .............�...... Distance-to nearest: Well ____..`.........-•..................Foundation ..._._�:�....__----- Prop. Line ......IQ........... � L�ACHING'LINEx k] No. of Lines _._.._.2.............. length of each line.-------�, Q.{..._....... Total length ......20.0'........... : 'D' Box ---2....... Type Filter Material .......2"....._.:Depth Fi)ter' Material .__.19!!...............................Al i � Distance to nearest: Well ...........,...�....... Foundation ..1�. .. Property Line . .__.. ,tC SEEPAGE PIT; [X] Depth _......�Q.r......` --�, �8.�t :�::.—:::Rock Fillet! Yes (D No =--Diameter A. pNumber. __. i y Distance tolneaeest• Well ..;.��0.............. Foundse,��.:...�'�.....-------....---- Water Depth --•- ----...... •........Rock S� 7 ._- .......,.�.�.r............. tion `�' 10 r: Prop. Line . ............. --•..............`....._..__...------------... Date....�-- ... ._. ... ..•----......... REPAIR/ADDITION(Prev. Sanitation Permit 5f-` � . ! ':Septic Tank (Specify Regiiirements) -----------.......16A0_. J •--------- ' -.........-•----------...._..............-------._._...............,� :Disposal Field (Specify Requirements) _ 200' Zeach___Urle..&.•�_--�51,11111� _"Xaa X1Q.................. ..I-----------------•--- '-----------------n......_--------------------------------------------------------------------------------------------------------------------------------------------- ......................... ..------.........-•.................. ..............••---•--• ------------......---- .t -------- ------. ............................................ (Draw existing and vequireci'additibn on revers�itidb)Y I h er`el ycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County` Milftnces, State Laws, and Rules and Regvlations of the San Joaquin Local Health District. Home owner or liven. sed agents/,signat re_certifies the following:._ �.�- --BGG_ "I'certify that;in the performance of the work for which this permit is issued, I shall not employ any person in such manner AL as to he�se�ubiect to Workman's Compensation laws of California." w Signed -------------------------------------{ .... ------------------------.. .:. ..----...._...... Owner f By 3 +, ......- -------- Title ------ 7"a c. r......................................... (If other than owner) i ' I FOR D �IRTMENT USE ONLY P APPLICATION ACCEPTED BY �` /.. - ..... - e..: :. DATE . ..7 41.. BUILDING PERMIT ISSUED _ ....DATE ADDITIONAL COMMENTS .............. .,... :.. .•----- --------_ .....................•-•--••--••---•--...:_..----- •._.............._----.--_._. .•--•--•--- •--....... Final Inspection. ... '- ,� '" -� .,r - ... .... ..Date " ..... L ..: t 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723-M 0. 14.13-24_1.,ea R.Y_snn --