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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT -------------------------------------- '_3--q43_ -- - - Permit No. __ __ (Complete in Triplicate)This Permit Expires 1 Year From Date Issued [� Date Issued/o_,jf __._.- '___" ---------------------- --------------------- 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: 1 No. A-lpine -------------- -----CENSUS TRACT .S l----------- JOB ADDRESS/LOCATION ------------------11-_ - ----- - -- --`-------- ADolen --------------- --Phon .x,20-2-7----------------- Owner's Name -------'--------------------------------------------------------------------------------- ----' �-3r1- Address ----- 76_20__TTs _,___El_Llosad.o--=------------------------------------ ------------ City -----------Stkn......... -------------------------------- Contractor's Name '31a ekard' S Septic Tank ----------------------------License # ----2!-9-951---- Phone _46-3m7048------- Installation will serve: Residence [3 Apartment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:------1____ Number of bedrooms ___2------Garbage Grinder ------------ Lot Size ________4Q___&x'es_______________ Water Supply: Public System and name ------------------------------------------------------------- ----,------------ ------------------------ ----Privatef] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan [2 Adobe ❑ Fill Material ___________ If yes,type _-_______________________ (Plot plan, showing size of lot, location of,-system in relation to wells, buildings, etc. must be placed on reXerse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f ] Size-.--- 5,x6,x10_ __________________ Liquid Depth __.48_'_1................ Capacity ------1200____ Type __Sg,_--_--_-_ Material____ 0011. ._ _ No. Compartments __.2............... Distance to nearest: Well _-_______-8_0'------_------------Foi7ndation'-----1-Q ---------- Prop. Line ----------2t}©_!_._ ; LEACHING LINENo. of Lines _ _ [� .._ _�___________ Length of each line;f__ __5o __ _________ Total Length --------100'........... Y 'D' Box _1_______ Type Filter Material ____2"____ ___-Depth Filter Material ___________ 1.9_'.'______________--_-__.._. Distance to nearest: Wellw__..._-foundation _2_0 ___ __________ Property Line` 1.000_!-- -- SEEPAGE PIT [xj Depth ------�_5_1______ Diameter J-31!-------- Number _______z_________________ Rock Filled Yes 1 ] No i❑ Water Tabl4 Depth -----------------94_'__'..- --------'---...Rock Size 2•"------------------- Distance ---- ------Distance to nearest: Well -----------10-0-___________________Foundation --------50-! Prop. Line ........ REPAIR/ADDITION(Prev. Sanitation Permit# ________________________________ _ Date ---------------------------------- Septic _______________-_____--__________Se tic Tank (Specify Requirements) 1200 Gal. Disposal Field (Specify Requirements) _100'-__-ea.oh.Lin_e__&----(-2_)---P 1-t-s---3-3"-X2-rj-'--- ------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------ --------------------- ---------- ---------------------- -- -------------------------------------------------------------------------------------- (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. 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------- - ---- -- _ - ------ _-Owner . - �� Contractor BY - - ----------------- Title ------- ------- - - --------- --------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY C - -------------------------------------------------------- DATE --------------- BUILDING PERMIT ISSUED ------------------------- ------- ---------------------------------------------------- -------DATE ------------- ----------------------------- ADDITIONAL COMMENTS ------------------------------- ------------ ------ ---------------------------------------------'--- ----------------------------------------------------------------------`I--------------------------------------------------------------------------------- ---------------------- ------------ --------------- - -------------- ---------------------------------------------------- ------------------------------------------------------------------- ----- ------------------ ----- - Final Inspection b Date -L'-~'3-- P Y '�-� SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M