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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT .............................................. 1 - -: (Complete in Triplicate) I k, Permit No. - .--. ... ............. ...... .�_.._.................... " 'This.Permit-Expires-] Year From'Date-Issuecl Date Issued ..5..-.9-7� 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. 544 and existing Rules and Regulations: JOB ADDRESS/LOCATION ........End of Berner Rode)-Thornton ................CENSUS TRACT ......_._..... ...... - i Travailles Att; Mr. Sariborri Owner's Name ...................-......................................................................................._.. ........Phone Address ..._..._.._E»-0...-.Box... &....18.91............................................. CitystnJaIr-ton....................................... ....... � Contractor's Nome Roto Rooter Ser. ...............L'++cense # .-271 3 Phone .465--2616 " ------------------- ------------------------------------------ --- Installation will serve: Residencsx❑Apartment House Commercial❑Trailer Court i❑ Motel C]Other -------------------------------------------- Number of living units:............ Number of bedrooms _.__........Garbage Grinder�eS..... Lot Size --.acreage Water Supply: Publ is System and name ........................... --------------------------------------,............_--------- .....................Privates❑ Character of soil to a depth of 3 feet: Sand . Silt❑ -Clay ❑ Peat❑ Sandy Loam ® Clay Loam ❑ v 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.{ 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 [ ] No. of Lines ........................ Length of each line............................ Total Length ............................6 'D' Box .----------- Type Filter Material .._.................Depth Filter Material ...................................___-__:-•-,d Distance to nearest: Well ... Foundation 1 ..................... ....._.._.............-. Property Line ......--•-------........ , R SEEPAGE PIT - Depth Diameter Number Rock Filled Yes 0 No Water Table Depth -••-•----••---••----•---• ......................Rock Size .......___.................. Distance to nearest: Well ......Foundation .._ Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit 56s _______........................... Date --------•-------------------------} Install a x. ' tight line and Septic Tank 1Specify Requirements) •--------------------------��-- •--..35......-_•_g..----..........-•-----......-.......---•-•--•------- �. 160 ' of leach line to home . Disposal Field (Specify Requirements) ....--:..._ .... ............................ ---------------------------------- -----•-------: ----• ----•-•---------------------------------------------- ---........_ --------- •,•----...--•_•---......... (Draw existing on,djecluired addition on reverse side) I hereby certify that I have prepared this application and jhat the work will be done in accordance withZan Joaquin. County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or 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 becoAsuj to Workman' Compensation laws of California." Signed .... •----_..._ . -- --- . - ---• ............•-••----- -•-•........._.... OwnerContracfor13y ........... ..• --•• Title ................._ .- _..__....._..._.. =r tha wnerj POR DEPARTMENT USE ONLY f :` APPLICAT N ACCEPTED BY _. .. __.... DATE .ti .:. .".7 ..............`. BUILDING PERMIT ISSUED - ------------ ---- DATE _.. = .................... ADDITIONAL COMMENTS ..............:...... ........................ ........... - t....' ., :._ ......................••-•----.........................._......--___.___..._..._._.._.__._...... ................................................._...__--_--.-•--------•-•---___..._...__-___.w. ... .....--•--------------••_ ..........•----.._.... '............�..•__.. ....._._....... .....__......tir. ............ ,.__-__. . .... ..__ .._ ._. -. Final Inspection by: .. - -.-----••----•...........................................••-•----•--••------.Date - ........ .. SAN JOAQUIN LOCAL HEALTH DISTRICT i E;H.13 241-'68 Rev. 5M 3 M