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FOR OFFICE USE: k ` / APPLICATION FOR SANITATION PERMIT� ----------- --i ------ (Complete in Triplicate) Permit No 7� l_._ - C_.1__ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to thkS 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: JOB ADDRESS/LOCATION _____. 66_-Arch Fad. _____---_______----____-_____--__CENSUS TRACT ..____________________ - --- Owner's Name ---------1+Zr;---Ma_Ge---------------------------------------------------------------------------------------- ---------Phone ---4'6-5"20.02--------•--- AddressSame -------•------------------------------------------------ City -S-tock-ton------------------------------------- - Contractor's Name -- Blackard'_S_Septic Tank _License #268951__-____-- Phone .__463-7048 Installation will serve: Residence7©Apartment House❑ Commercial ❑Trailer Court I❑ Motel ❑Other -------------------------------- Number of living units:__1---___ Number of bedrooms _2--------Garbage Grinder _""_____ Lot Size -_-___-___ Water Supply: Public System and name --------------------------------•---------------------------------- ------------------------------------_--_-Private:K] Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe el 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: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size________________________________________ Liquid Depth -------------------_,_-_-- Capacity ------------------- Type -------------------- Material---------------------- No. Compartments --------------•-•- Distance to nearest: Well ----------_-------------------------Foundation ---------------------- Prop. Line --------------__._.... LEACHING LINE {C] No. of Lines ---------/--- ------- Length of each line-----/_ -_�---- Total Length -1-00*, _ 'D' Box ---/------ Type Filter Material ---2"------------Depth Filter Material ---- .9................................... r\ Distance to nearest: Well _ C� ----- Foundation -------4_2_'_ ---------- Property Property Line __. f .......... SEEPAGE PIT ] Depth .....25*__----- Diameter _-4'8'I_------ Number _1----------------_------- Rock Filled Yes rl� No 0 Water Table Depth ----------90---------------------------------Rock Size _2_ -------------------- Distance to nearest: Well ---------4-_2<---_----------------Foundation __114�------- Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date _---_---_---------______..........) SepticTank (Specify Requirements) ----------------------------------------------------------------------------------------------------------•----•---------------------------- Disposal Field (Specify Requirements) ------------100 Leach Line & 48"X25'$it - -- - -- ------ -- -- ------- --- -- ---- -- ---- - ----- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ (Draw 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: "1 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 G - By -------rl=f�c.` - ( Title ---- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------ -------f---------------------------------------------------------------------------- DATE7z'---------- BUILDING PERMIT ISSUED _ ___.__/__ - DATE ___________________________________________ ADDITIONAL COMMENTS _04A- --- eayf- �Cq, i_iurzst -, �' ---- ----------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- --------------------------------------- ---------------------------=--------------------------------------------------------------------------------------------------------------------------- -------------------------------------- ---- p y: ---------- - Final Ins ection b ------------------------------------------------------------------ -----------------------------Date ____1-:2-.�,1--7 -• SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M C