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FOR,OFFit,, USE: APPLICATION FOR SANITATION PERMIT ----------- ------------ ---------- ------ }} (Complete in Triplicate) Permit No. - ------------------ 1 h/"7�-/� --------------------------------------- This Permit Expires 1 Year From bate 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. 549,and existing Rules and Regulations: JOB ADDRESS/LOCATION .------- __?214 Ro_birida &-_. e ms-- '-' CENSUS TRACT ":- ----_-.--- Owner's Name -F'ree'd.-Sr,L�der---1------------------------- ------•------------------ ------------------------------------------Phone - 94a-Ti5Z-62------- Address ------- ---aania----------------- # - City - Stk22 e- i --------------- --•- ------ ---------- Contractor's Name --- 3-1-aerd s-S-t- -6 -e 1's32it ------License # ----26.-$95 ---- Phone ----46-3_-�_Q48----- (f Insta-llation will serve: Residence ❑Apartment House❑ Commercial ®Trailer Court i❑ Motel ❑Other -- .� Number of living units:-----I------ Number of bedrooms' ___2------- Grinder ------------ Lot Size _-110_1X200_'__________________ Water Supply: Public System and name -------------tyP-Jty-----_-------------- --------------------------------------------•--------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ,❑ Peat E] Saintly Loam E] Clay Loam ❑ } u Hardpan E] Adobe n Fill Material .-t----- If yes, type --------------------------- - (Pl'ot 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,) N S N. PACKAGE TREATMENT { ] SEPTIC TANK fx] Size--_-4'x5'x10-1_-_"`:_--'_--______ 'Liquid Depth --- r` ---------- Capacity Ca acitY - 12H ------- Type --- �1-----:--- Material No. Compartments --2-------'---------- Distance to nearest: Well .,4. -----___--------------Foundation ------/�-�---- Prop. Line -------.1—-------- LEACHING LINE [ j No, of Lines ___--.I---------------- Length of each line.-------199 --- Total Length 1-001-,., 'D' Box --_ ---1.-- Type Filter Material --2"--------------Depth Filter Material -----1-.-!'__________ � ~` ------------ wsDistance to nearest: Well -_--�..------------- Foundation Property Line ------------------------ r - # ---------------------- - __---------- Number --.-- ------ Rock Filled Yes : ] No SEEPAGE PIT [3J Depth 2 �__-----_-__- Diameter 10 1 Water Table Depth -----------9Q-------------------- ------Rock Size --------201 i Distance to nearest: Well ___-----------------------_Foundation _--,1,�-. Prop. Line .---.-- .......... REPAIR/ADDITION(Prev. Sanitation'�Permit# -------------------------------------------- Date --------------.------------------_) Septic Tank (Specify Requirements) -----.-----2XIRJKi iffii MK2RlAk±iK L'iX--1200---Ca.,l..---.S-elf-t1.0---Tank--------•------•---- � Disposal Field (Specify Requirements) ----10_0-'---Leach---Ll-t'i-e-----&---36'-=X25r'---- - -- -------------------------------•--------- il --------------------•----------------------------------- ------------------------------------ --------------------------------------------- ------------------------------------------------ " J(Draw existing and required addition on reverse side) I hereby'certify that I have prepared-this application and th ate-the •work-will-be-done-in—aicardance with--San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin.L'ocal Health District. Home owner or licen- sed agents signature-certifies the following: , "I certify that in the perforinance 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`.Compensati.on laws of California." ` Signed - -- - -- s .Owner.. BY ------------ -Title ------- " ----------------- I (If other than owner) -� FO EPA-RTMENT USE ONLY `!_ i APPLICATION ACCEPTED BY -------- -----' - - ---------------------------------- -- DATE -.-_: __ l-7Y--------------- BUILDING PERMIT ISSUED -------- - { -------DATE -------- ADDITIONAL COMM TS -___ -.- - - - - ' - - ----------- --------------------------- ---------------------------------------------- --------------------------- f'f 7�----- - -- - ------------------------------------ =----------- ---- -- _.. _ , - -- ------------------------------------------------ -------'------------------------------------/ -"-- F ------------------------------ - ------ - ----------- = ------------------------- --- ` Fina! Inspection by: - = --------------------------------------i=--- ----------- .Date SAN JOAQUIN--�l:OCAL HEALTH DISTRICT E. H. 9 - ]-'68 Rev. 5M -