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FOR OFFICE USE: APPLICATIOW FOR SANITATION PERMIT ---------- 4__`� - - -.----- Permit No- --- ------- jj (Complete in Triplicate)--- ------- - _t--�- Date Issued __________________________________________--------------- This Permit Expires 1 Year From 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . 5044---E:___Axd-ella----------------------------------------------------------CENSUS TRACT -------__--- ".. - Owner's Name Mr..-__F-ou_t_z------------------------------------------------------------------------------------ -------Phone ---�'65-. U----------- Address --------Same--------------------------- - City Stkn.-------------------------------------------------------•------ Contractor's NameBla. kar_d!_S---S_eptiia__Tat1-k----------------------_--------License # ------26.8_9_51--- Phone _____Ilb p1,1 --- Installation will serve: Residence 1]Apartment House,F Commercial ❑Trailer Court ;❑ Motel ❑Other -------------------------------------------- Number of living units:__1------- Number of bedrooms 2----------Garbage Grinder ------------ Lot Size ----6.p-t_X-lap-r____________________ Water Supply: Public System and name ------------- -------------------------------------------------------------------------Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ 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 reverse side.) G, 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 :F] No. of Lines "------1-------------- Length of each line________1.1.p_t------------ Total Length ------4().#............... 'D' Box 1______- Type Filter Material --------. !!-------Depth Filter Material ____}_9t!................................. Distance to nearest: Well »..-___ Foundation __20_-_______________ Property Line -----1Q�.._-_.._._.. nTP*4U'F'PIT [} Depth ----- - Diameter _-4_'_X$'__ Number ----1______-___-_____-- Rock Filled Yes '® No C] Sump Water Table Depth 9.Q!______________________•Rock Size -------27_-_--__-.-___----.. Distance to nearest: Well --------r--__—-----------------Foundation -----4Q_-------- Prop. Line ........... REPAIR/ADDITION(Prey. Sanitation Permit# -------------------------------------------- Date ---------------------------------- Septic _______-___________--___•-------_Se tic Tank (Specify Requirements) __ -w Dis osal Field (Specify Requirements) ________ 40' Leach_-Line-_&_-Sump_- fX_$'X10_!_________________________ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- (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 By --- Bill Blackard - Title ----- on-tractor-------------------------------- - -- (If other than owner) FOR DEPARTMENT USE ONLY APPL CATION ACCEPTED BY - DATE vZS-7 . BUILDINGPERMIT ISSUED --- --- -------------------------------------------------------------------------------------- -------DATE -------------------------------- -------- ADDITIONAL COMMENTS -- - - ---------------------------------------------------------------------- ---------------------- --------------------------------------------------------------------------------------------------------- FinalInspection bY: - ----------------------------•------------------------------------------------ Date - CJ ---------•------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M