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FOR OFFICE USE: - 3( APPLICATION FOR SANITATION PERMIT ------------------------------ (Complete in Triplicate) Permit No. _.�. _----_---_-- 1 ------------------------------ This Permit Expires 1 Year From Date Issued 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-isrmade in compliance with County Ordinance No:549 and ..existing Rules,,and Regulations: JOBADDRESS/LC►CATION'--__.20-- �l_. ?a "" '. '-'_ _---_- --..-_ ---------_CENSUS`TRACT"'"""""":_---------------- Owner's --Owner's Name i �aT' F el]-ipS----------------------------------------------------------------- --- ---Phone 7C- �48.5!r_73B6-_ Address -P Box- 322---------- --- ------=------------------------------- ............... City Cal-Pella_, Calif. ----------------- •-------.------ Contractor's Name 131aakard-s_s---Sipti_c-__Tank------------------- ------.License # -------2:�3951.__ Phone ----�'63!-`7Vka.--- installation will serve: Resid=ence] Apartment House,❑ Commercial Trailer Court I❑ f Motel ❑ Other 75'X100 Number of living units:--- _R Number of bedrooms -----------Garba_ge Grinder ------------- Lot Size --------.--_--_ Water Supply: Public System and name .... ----------------- -Citi __-__---_-_--Private ❑ 'i ------------------------------------------------------ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ Adobe Z] 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: fNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) ` PACKAGE TREATMENT [ ] SEPTIC TANK`[ ] Size-----------------------------------•- -----.---- Liquid Depth -------------_----- _ ------- P Y z TYpe )Ula#eriai_--------- £ No. Compartments ------ ---------=---- ` Distance to nearest:=Well ------------------------------------Foundation ------------.-_------_ Prop. Line __...--------:...-- --- LEACHING LINE Pd No. of Lines -----1.__-- Length of each line_ 4Q'----------------- Total Length 0-----_------_-------r 'D' Box .1---:----- Type-'Filter Material -__2`"------------Depth Filter Material ---------1- -"------------------------� -- Distance to nearest: Well ""_"---------------- Foundation 151 ------------------- y ----- - --- -------- ter ------- ter - '*__-_-- Number1-.-.____-_.---____AGE PIT Depth -25........ _-- Z Rock Filled Yes 29 No ,❑ I Water Table De -th --� ' -------------Rock Size -2"------------------•----. .� ! { Distance to nearest: Well _'--_-_-----"-7 ----------------Foundation 70 � . 1 ----- -------- Prop. Line ----------------- REPAIR/ADDITION(Prev.:Sanitation Permit# .. -_------------- Date -__--_-_-_-----_.-------- ---------__-- `j -----} '� 4 Septic Tank (Specify Requirements) ---------- ----- ----------------------------------------------------------------------------------- ---------------•-------•-- Disposal Field (Specify Requirements) ------4! Leach Line & (1) Pit 33" X251 --------------------------------- - ------------------------------------------ � y. -------- --------. ------------------------------ - i. - ---------------------------'--------------- --__- -- - -------------------------------------------------------- (D�raw'existing and required addition on reverse side} I hereby certify that 1 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. Home owner or lio' sed agents signature certifies the following: ^ "I certify that in the performance of the work for wli ch this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation.lows.-of:Colifornia." Signed --------- -------------I--------------------- - ='----------------------- Owner BY - '---- - - ------- -------------------- - r-`--=-;--- ~ . Title -----C.oTitra.0 t4x'. (If other than owner) � FOR PARTMENT USE ONLY APPLICATION ACCEPTED BY - - --- ------ ----------------------------------- -- --------------------------. DATE _'—"?_0_-` BUILDING. PERM.IT�JSSUED - _ �._ _�.. ADD1TfONAIMMENTS ----- - - _...,._ :- - _DATE - - ------------- ------------- ----------------- ------------------------------- ► -------------------------- ----- ---------- � --------------------- ------------------------------------------------------------ r ------------- V ------ --- Finai Inspection by: ---- Date ---l,r-:/ AN JOAQUIN LOCAL HEALTH DISTRICT / E. H. 9 1-'68 Rev. 5M r