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FOR OFFICE USE: j`� y---� ................ APPLICATION FOR SANITATION PERMIT (Complete In Triplicate} Permit No. .. ......................_._._..............-----• _ ........... 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 made�in compliance with County Ordinance No. 544 and existing Rules and Regulations: J413 ADDRESS/LOCATION ....,:...-_... /.Z..d.QrZ1er_... f...H�rrlerAa� d...Adelbert......CENSUS TRACT ......_............_ . .. Owner's Name .....Jirmie Wincheli ' Address 3.8 5... ..... ain.•-......----••••-•-• • :"Phone . ............ ........ --------- Contractor's Name _S_...... o.t.o..RQ01e ...S.euer-.Sex_......-------_-- 2-715-3.9 ..._.Lieense # ......:.. Phone ..l�:b5--�Ealb._•.-.. Installation will serve: Residence C�Apartment House❑ Commercial '[]Trailer Court 0 { Motel ❑Other ............................................ Number of living units..........J_ Number of bedrooms .._._....Garbage Grinder __ mss.. lot Size ....61..x_.123................. . Water Supply: Public System and name ........Cali'. Water; Ser. .Private ❑ Character of soil to a depth of 3 feet: Sand ❑ Silt❑ .Cloy ❑ " Peat Sandy Loam ❑ Cloy Loam ❑ Hardpan [] Adobes'] Fill Material ._.....___ If yes,type ................ --- ... . (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side,): :'NEW INSTALLATION: INo septic tank or seepage pit permitted if-public sewer-is available within 200 feet,) ' PACKAGE TREATMENT r ] C TANK Size....... r x 5 i X r __. Liquid Depth 02- Capacity i SEPTIC re cast concrete Capacity ..............„--- Material----...-__---- No. Compartments -- TY -_... Distance to nearest: Well ......�?/- -................. Foundation 10 ' Prop. Line ...5 .............. i LEACHING LINE [ No. of Lines 2..----.____•..... Length of ears line...-------- 7 r 851&851 Total 'D' Bax Y roc __.. --- Type Filter Materia( ... -•--..."..._.Depth Filter Material ............. ............ . .� ;,. Distance to nearest: Well -_n/..a.............. Foundation ...1-0.f.... .........i Property Line r SEEPAGE PIT lx) Depth 25--1 tr p rtY �................. Diame 3...._ Number ............. , t t r1211•----•5 ��rFilled Yes [ No ❑-� Water Table Depth ••-.---- "--------------------------------Rock Size _ °...... ---• Distance to nearest: Well ..--�� -------------- Fou_ ndation .10-! ....... Prop.Prop. Line .5!.....__.-- REPAIR/ADDITION Prev, Sanitation Permit�# l ----_. Date Septic Tank (Specify Requirements) .:................................... ,x ---.....................- :.. ................. s Disposal Field (Specify Requirements) r ---. --•- ••---- _ .... r _._.._.•. • ------------- ---------------------------•----..................................(Draw existing and required addition on reverse sidel 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin s 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 "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 ..-- --.--- ..._...:.... :_ Contractor l --------------------••----• Title .._._..__......_.. .._..._......_ .. If' t er than owner) 9 E TM T S ON Y APPLICATI ACCEPTED BY.._ _ BUILDING PERMIT ISSUED ... ......... . . I•- -- -•--• --••.. ................ ... . . _.: .__.�'.�._.1�:..._. DATE ....a�...:--..z..�..2.5.....: .............. ----------------- --•••---- ...... . DATE ADDITIONAL`COMMENTS ....... ----- ::: 1: : - = ---7. .. --••------------ .------ _•_•__••........................R.... _ .^� o Y•.a�_ :� ------•-I....__..._--.... •.................. f -• ___ .. _- .�_. _yz Ficial Inspection by: ...... ...-.••.•'• c -1 .-----.Date 7� SAN.JOAQUIN LOCAL HEALTH DISTRICT I E. H. 13 241-'68 Rev. 5M