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FOJR OFFICE USE: APPLICATION FOR SANITATION PERMIT --� w�� `� -- -------------- Permit No: — �-� 3 i �. (Complete in Triplicate) ' ------ ------ ----------------------------------- --- 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- DDRESS%L"OCATION ---------------------------------- -..��.�...�-------- --CENSUS TRACT ------- `""--------- 4 _ -------- -Phone ---465-195.9 Owner's Name Mr..---John-so 7----------------- � -� �_.__� a Address$qMQ------ City - = Stkn.-------------------------------------------------------- Contractor's Name --: _filaokar-iV-s----------------- --------------------------------------License # _268951------- Phone 4,6-3-.7-049--------- will=serve:, Residence f]Apartment House-E] Commercial :❑Trailer Court 0 "Motel ❑Other ------------------------------------------ Number of living units:_--.1----__ Number of bedrooms ------2---Garbaa Grinder ------------ Lot Size _._b 1- f4' ' --------•-Private ' Water Supply: Public System and name_--------- Cit ❑ iL `Character of soil�0 a depth of,3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 7 # Hardpan ❑ I -Adol;e® Fill Material" _- If yes, type 4 ______________________---- 1 i (Plot: plan,..showing size lot'l,location of system in relation to wells, buildings, etc. must be placed on reverse side.) E .NEW INSTALLATION- (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) E 'PACKAGE TREA�fMENI [ 7 SEPTIC TANK [ J Size---- ----`------------------------------------- Liquid Depth -------------------------- Capacity -----.�,--;--------- Type -------------------- Materia(-'-----•------------- - No. Compartments ------•----=-----:---- � F i Distance to nearest: Well ------------------------------------Foundation _ ------ Prop. Line -----------:--:--.._ LEACHING LINE [j No. of Lines -------- --------------- Length of each line---------- 70-':_-_______ Total Length ------7D_!___.... _____- 'D' Box ---- Type Filter Material -----2'_'----------Depth Filter IMaterial ---19!r--------- ---------- Distance. ----Distance. to nearest: Well________ ------Foundation -_----____ Property Line __________7 SEEPAGE PIT ], Depth ----------2-5-1--- Diameter -------4_8"__ Number -----------1-------------- Rock Filled Yes ® No El t 4., Water Table Depth ---------- -------------------------Rock Size ---------?-t------------------- Distance :------------- Distance to nearest: Well _ -------- -�,;,�_---------Foundation -_-___._�fl�_---. Prop. Line -----2Q.____.._... REPAIR/ADDITION(Prev. Sanitation Permit# -______.�`-� .------- ------ Date ----------------------------------1 r� t _ ------------- - f Septic Tank (Specify Requirements) --- ..------ - Disposal Field (Specify Requirements) --------------0...... each--Line-A--- 8'---X--2Si---Pit---------------------------------- ---- v� ----------------------------- -- ---------------------------------------------------------------------- -------------- --------------------------• ------------ (Draw existing and requit=ed`addition on reverse side) II 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:'.loaquin 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 --------Bila.__Blackard -------- Title -- --c_ontractor--------------------------------------- (if other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___ ._._ _ ---�' �`- - --------- --- �-- -' - �a- - DATE ----- BUIL-DING..PERMIT._ISSUED--- ------------------------------------------------------------ -- -------DATE ---------------:------ -------=---------- T ADDITIONALCOMMENTS - --------------------------------- ---------------------------------------------------------------------------------------------- --------------------------- ----- -------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- --------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- ------------------------------- -- ----- E�Final Inspection by: ��r�?- ------------------------- ----------------------------------------------------------- -------Date ---------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1-041- E. H. 9 1-'b8 Rev. 5M