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FOR OFFICE USE. APPLICATION IOR SANITATION PERMIT --------------------------------------------------_ :i Permit No: _7�_1----�--- (ComPete in Triplicate) ---------=--------- ------------------------------------ --------------------------------------------------------- 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 is made irlcompliance with C,6 unty Ordinance No. 549 and existing Rules and Regulations: Fief_ _-flodi--_-_Q '_ -__Front ;et. ---CENSUS TRACT -------------- •-------- JOB ADDRESS/LOCATION .-�--For-e�s_t.--Lemke:-_ Owner's Name __LbrP_r.__Per Road' M? lot aNorth side �-- - -------- -------------------- =---------------------- ---- --- - •--- - ---- Phone 1-209-_3�8-913:5 Address -2.107---Jerry---Laaer--- Ii City ----nod-i-------------------- ----------------------•------ -------------------- Contractor's Name ---CA'1-,WeatLer:_1__S ani %ati0nx TrIGO License # __182784_ - Phone ---3"`8471 Installation will serve: Residence X]Apartment House❑ Commercial ❑Trailer Court ❑ Motel ❑Other ------ --- -----------------•------------- Number of living units:_.___.----- Number of bedrooms ____-----Garbage Grinder ------------ Lot Size -S5_� X__584-1- - l�Water Supply: Public System and name ----------------------------- -------------------------------------------rF-i-----------------------------------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ _Sandy Loam ❑ Clay Loam;❑ Hardpan ❑' Adobe�o Fill Material ----- ------ If yes,type _-__--_________________-_ r (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) U NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} 11.0 PACKAGE TREATMENTf ] SEPTIC TANKTK] r Size----_100---g$14 ___ Liquid Depthth ___--___ -_ Capacity ._1290:__ga3rype -------------------- MaterialNo. Compartments ---2'------......... Distance to nearest: Well ----_____---------------------------Foundation;_____________ 54 ---------.Prop. Line ---------------------- I LEACHING LINE ( ] No. of Lines --------all--------------- Length of each line--------- 00--- ------_- Total Length _Z00-1 D' Box I_--------- Type Filter Mate(ial _QQt!_ PCepth Filter Material --------------------_______________.__.____.- Distance to nearest: Well ---- ----------- Foundation ___ Property Line SEEPAGE PIT ( ] Depth ------ Diameter ------- Number ---- -------------------- Rock Filled Yes 'ff• No i❑ Water Table Depth ---------------------- -------Rock Size = obb@ i Distance to nearest: Well ------W0i-------------------------Foundation -------------------- Prop. Line -----.-_•----.---.- REPAIR/ADDITION(Prev. Sanitation Permit# --------------------- ---------------------- Date _________-_-________..-.__...._.__} Septic Tank (Specify Requirements) ---- --- -----------------------=�------=----------------------------------- -------------------------------------"I--------- -------•---- i Disposal Field (Specify Requirements) ----------- .' ._ . . ._ - -- - --- --- ---------- -------------------------- ------------- - -------- -------_-_----- - --------------- ------------------�^" --------------------- -- Is (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 Regulation's of the. San Joaquin local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person in such manner as to become suble it to W man's Compensation laws of California." - w„ Signe t �it�.Oti. I11C. f -- --------------p--- Owner ' B -- --- ------------- Title ------Freai.dei Fro:ai.dAnt------------------------------------------ a ' ( f other than ow ed E .i F R DEPARTM SE ONLY APPLICATION ACCEPTED BY f__ . . _ ._ __ '- DATE ___ ._-__2.6•x_ -. �-_.__ ------- ------------- - BUILDING PERMIT ISSUED ----------------------------- ------------------------------DATE ---------------------- - �4 ADDITIONAL COMMENTS ---------------------------- l - ---- ----------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------�i ------------------------------------------------------------------------------------------------------------ " ; ' ---------- -------------------- - �------- Final Inspection by: _ -- --- - Date _----�'-�-s __ _ -Y__ SAN JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M, A k � 4