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FOR OFFICE USE: APPLICATION sOR SANITATION PERMIT --------------------------------------------------------- Permit No. - -Z'--Z----_ (Complete in Triplicate) ------------------- - -- - - - ---------------- T Date Issued ----- ---- -------- - -------___------ -1_---___-_-_-----___----- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described This �ppIi t� ad in corn nce with County Ordinance No. 549 and existing Rvles.and Regulations: d �g f G --------------CENSUS TRACT --------------•--------- JOB ADDRESSlLOCATION _-On 6a i- ---FeFv-ry---Raad---------------------- - Owner's Name ----Jerry---Atkins----------------------------------------------------------- Phone -_Z--p$5-34.t t Address -------------------- ---------------------------------------------- ----------------------------------- City -----------------.------------- ---------------------- --------------- Contractor's Name Cal-We stern Sanitation, -I_.___________-_.License # -_ 181'7.84---_ Phone48:i-�3�:'71 Installation will serve: Residence ®Apartment House❑ Commercial:Trailer Court ,❑ Motel ❑ Other -------------------------------- ------ Number of living units:-----1---- Number of bedrooms __2-------Garbage Grinder -.---------- lot Size ---*!EQ Water Supply: Public System and name ------------------------- __---_-.---------------Private [Z � Character of soil to a depth of 3 feet: Sand'® Silt❑ Clay ❑ -.Peat ElSandy Loam ❑ O9 Clay Loam ❑; M Hardpan ❑ Adobe 0 Fill Material ------------ If yes, type ------------------------ -- ,1 (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------- - gallog------------ Liquid Depth --------------------------- Capacity ---.-----_- - CapacityX20 =--_-.-- Type _"aext_t---- Material---ce-ment---- No. Compartments ----a--------------- Distance to.nearest: Well --50 t---------------------------Foundation ---------------------- Prop. Line -----------=---7------ LEACHING LINE [ ] No. of Lines ---2.------------------ Length of each line----------90-f----- :"--.io#a1 Length- -----1.801_----------- 'D'.Box ------------ Type Filter Material --------------------Depth Filter Material --------------------•------------------------ Di stance ------ ---------- Distance to nearest: Well 0 ______________ Foundation ------------------- Property Line ------------------------- SEEPAGE-PIT ---_--_-------__--_----SEEPAGE;PIT Depth -------------------- Diameter __ ---:_-_- Number ------------------------ Rock Filled Yes '[) No i❑ Water Table Depth ------------------------------------------------Rock Size ------------------------- ----- Distance to nearest: Well ----------------------------------------Foundation ---------------•---- Prop: Line ----------=:*..--.. REPAIR/ADDITION(Prev. Sanitation Permit# ----------------- -------------------------- Date ----------------------------------I E Sepfiic Tank (Specify Requirements) -- ------------------------------------------------------------—--------------- ------------------------ Disposal Field (Specify Requirements) ------------- ---------------- ------------------------------------------- -----------------------------------•--------------- p p (Draw expspting and required addition on reverse-side) �—q- — -�-=- — `" Ihereby tify 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, 1 shall not employ any person in such manner fas to become subject to Workman's Compensation laws of California." Signed ---C-al-_;Yes t..er- _ -Qtx-aa,---1010- -------------------- ' 4 By --- r --- -. 'w w' Title Pr..e sidex>t ilf other than ownbf) {' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- -11 DATE -/_-----7 - -- BUILDING PERMIT ISSUED -- ---- --------DATE ------------------------------------------- -------- ADDITIONAL COMMENTS --------------- ----------------- ------ --------------------------------------- ------------------------------------------------------------- ------------------------------------- -- - -----=------- Final Inspection by 7 Date = - 7 - ----- --- ---- SAN OAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.