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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 3Z_-_Y3_9 . (Complete in Triplicate) ---------=----------------------------------------------- ---------------------------------________________________ This Permit Expires 1 Year From bate Issued Date Issued _ :.Z__ 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 I Regulations: JOB 'ADDRESS/LOCATION ---- --�20�� OAkWOOd---------------------- - ---.CENSUS TRACT --------------------- ----- Owner's Klame --`T�TfiQs e11----------- ---------------•--------- � �_...... . Phone 462- - Address ------Same------------ ------ ---------------------------------------------- ------- City ----------St n------------------------------------------------------- Contractor's Name ----Blackard''-s-------_ ----------------------------- --------License # ---268- 1l.� __.__ Phone ___ 63--7_04g___-__ Installation will serve: Re1'idence ® Apartment House-[] Corr merciaf-❑Trailer-Court-;EI ---�- s t ! 'Motel ❑Other -------------- --------------------------- Number of living units;- --------- Number of bedrooms -----3---.-Garbage Grinder Lot Size --------�_Acr-,as___________________ J Water Supply: Public System and name --------------------------------------------------------------------- ----------------------------------Private ] I Character of,soil to a depth of 3 feet;: Sand![] �Silt 0 Clay ❑ Peat❑ Sandy Loam ❑ Clay'Loam ❑ J Y 'Hardpan ❑ Adobe Fill Material ------------ If yes, type ---------------------------- dd (PI'otplan, showing-size of lot, location of system�in relation to wells, buildings, .etc. must be placed on reverse side.) NEW INSTALLATION:l (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ,i O PACKAGE TREATMENT [ ] SEPTIC TANK;[ l Size___________________________._____-._..________ Liquid Depth r � _ ___:-------_.-------______ , � oCm arfinents ______._____.:_-:.___ b\capacity -------------------- No Distance,to nearest: Well.----------------------------•--------Foundation ---------------------- Prop. Line -.-.------------------ V LEACHING LINE [ o No. of Lines -----7.----------------- Length of each line._____._.____--40_x.------ Total Length -------40.1 � 'D' Box ,.__7.__.___ Type. Filter Material ------2_'__________Depth Filter Material _.____� - -' Distance to nearest: Well _-_- - - t - ----Foundation___ } 1O&_ -- 100 Property Line _50-1 --------- - SEEPAGE PIT fg] Depth Diameter __ 11__.____ Number -------I__________________ Rock Filled Yes ® No 0 i Water Table Depth --------- 40 11------------------•------------Rock Size -------2.!- -------------------- Distance tolne'arest: Well _-____,_1.04�____________________Foundatiorrl0p_-__-_____.____ Prop. Line ____.___ Q'_.___.. REPAIR/ADDITION(Prev. Sanitation IPermit# -------- —-------------------------------- Date :-_--------------------------------) Septic Tank (Specify Requirements) -------------------------- - "`�-------- ! • - I Y� - 4 Disposal Field, (Specify: Requirements) ------------------40 ---Leac-h- L-i a------ '-P-1t---2rj-a 36-e--------------------------------------- �%,. , -- ----------- -------------------------- --------------------------------------------------------------------- ------------------------------------------ --------------------------------- (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 foliowing-- "I certify that in the performance of the work for:which this permit is issued, I shall not employ any person in such manner t as to become subject to WorkmanYCompensation laws of California. k Signed -------- ------------- - "_. Owner a` - By ---- - -Title'`--- 1z (If other than owner) i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY t� - -------------------------------------------------------------- ----------------- DATE -------- ----------- ' BUILDING PERMIT ISSUED ---- .._.---------- ------------------------------------------------------------------- �':_._DATE ------------------------------------------- :. ADDITIONALCOMMENTS - ---- ------------------------------------------------------------------------------ -----------------�'=----------------------- ------ ----------------- -- ---------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ---- -------- -- --- ------------------------- -------------------------------------------- ----------------------------- ------------------------------- -----~-- ------------------------------------ - ---------------------- -- Final Ins ection b Date ___ - _____________ p Y -10=. SAN JOAQUIN LOCAL HEALTH DISTRICT 'f C: ice. E. H. 9 ' 1-'68 Rev. SM �