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,_ -.,mow— -...- FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 1671 ...... --- Permit No. . ... (Complete 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 madin com (ianc vyith.County,�0�d inance No. 549 and existing Rules and Regulations: (� � .1 JOB ADDRESS/LOCATION ..-...-©n. E.--.-Side of klpine Road appx. 600 yd. N. 0� �kX Jane Owner's Namgd Riley.......................................................................... .....-•••._.. .. _.............Phone ......_.......•..................... Address ...'lo..:T.....SaccAzte--......2- 5__W --SmainRa.ad........................... City ....St©ckiron....................................................... Roto Raoter Sewer - era license tgt27k1539 Phone4.65-26Z6•.............. Contractor's Name ....... --t ..--.- .--- ------ ------- -•S••-•••---•..... 39. Installation will serve: Residence(M Apartment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ............................................ Number of living units:....1...... Number of bedrooms _..........Garbage Grinderyes.--..._ Lot Size .._-..._._11 acres ` Water Supply: Public System and name .......................................-......................................................................Private V Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam D Hardpan❑ 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. ,7 NEW INSTALLATION: (No septic tank or seepage pit permitted if pubjicbsewer ibava�ilable within 200 feet,) 4 , PACKAGE TREATMENT [ ] SEPTIC TANK tx] Size...................y__5......y.............. Liquid Depth _.._.. ........._._....... 1200 recast concrete 2 Capacity .................... Type P..._........--..•. Material..._-__...._...___.... N o. Compartments .. ............... Distance to nearest: Well ........5p........................Foundation .....-. 1.._._....... Prop. Line .. 51 N 2 85. 85' 170 t................h LEACHING LINE r] No. of Lines ........................ Length of each line............................. Total length ........................ 'D' Box Ye.*-.... Type Filter Material .........Depth Filter Material ........18.. ............... ' 10' Distance to nearest: Well ........................ Foundation .:...................... Property Line .... ...:.:.:. SEEPAGE PIT [x] Depth ...-.-- .....................2 ...... Rock Filled Yes [� No Q IF 25 -_.... Diameter .33_.......... Number Water Table Depth ..................... -••---......._.........._...._.. , 51 Distance to nearest: Well ........................................Foundation ..10._..........._ Prop. Line .. .................' REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. ) Septic Tank (Specify Requirements) .............. .. ...............•----._._.._...........-•---......--•---............,:......._•....._. .....__. .. .............. DisposalField (Specify Requirements) ................................................................................................._............._....................... ..-- ---- -- . tDraw 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 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 Workm 's Compensation laws of California.” Signed f ..... ... ................................. Owner Contractor By — -.t.. ... :.. . . . .. ......... .......... ... ..................•--••....... Title ................ ( f other than owner) F DEPARTMENT USE ONLY APP ATION ACCEPTED BY .. _....... ......................... DATE ... BUILDINGPERMIT ISSUED ......................................_........................ .......................................DATE ........................................... ADDITIONALCOMMENTS ............................................................. ..................................................................:........................... ......................................•••........ .. .. . .... .__.......•--......-• •-••-•...--•-•••••.._.......... ...................... ........._.. . ................................................ ..... ...... ..... ... •••-----•.....--•••--._._...._...................... Final Inspection by: .............�f{" '".. ........................ ..........................................Date .., / •�� y�x�... SAN JOAQUIN l HEALTH DISTRICT E. H.13 24j.'68 Rev. 5M 7/723214