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FOR OFFICE USE: " APPLICATION FOR SANITATION PERMIT a J 4 (Complete in Triplicate) Permit No. --- -------------- ----------------'--------------------- - /� ( _______ _- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the S n Joaquin Local Health District for a permit to construct and install the work herein described. This application is made irr compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION --------------- _ , 26------- Hiway 26 - CENSUS TRACT Owner's Name Fronk___Cedlll.a--------------------- ------------------------------ PF�one 931-210- Address ------ SaM-e ------------------------ - City `fit; -----------------------------------------k Contractor's Name ---- laCka - -----------------------------'s. --------------License # --26-8-95-1------ Phone -_1.I6 - - - ------ - Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court Motel ❑Other _NIob13---Home----------------- Number of living units:----I------ Number of bedrooms-_2---------Garbage Grinder ------------ Lot Size -5---Ac-rdo----------------------- Water Supply: Public System and name ___________________-- ___ -------------------.-Private:u ----------------------------------------- -- Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat ❑ Sandy Loam,•❑ Clay Loam ❑ an Hardpan Adobe M Fill Material ------------ If yes,type ____________________________ (Plot plan, showing size of lot, location of system in -relation to wells, buildings, etc. must be placed on reverse side_) W NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK'[)d Size_- w X5'x10:'_________________.. -__ Liquid Depth ---48'_____-_..__,____. Capacity ___1200Type _SSS._----------- Material---Conexet-eNo. Compartments --------2_-_ Distance to nearest: Well -----1-00!--------_------------Foundation _-6q-°------------- Prop. Line __S............. ._ LEACHING LINE (31 No. of Lines _ _________ ____ Length of each line J-0-0 1____'- ------ Total Length --------1_QA!---------- D' Box --__ ------- Type Filter Material -------- "__-_.---Depth Filter Material ------------ _g!J_______-__I. Distance to nearest: Well -----6-0!------------ Foundation ------60 f-__________ Property Line r SEEPAGE PIT' [ Deppth -------------------- Diameter ___-__-�6___ Number ---1--__r___________________ Rock Filled Yes Fr] No i❑ Water Table Depth ---------�90-e_______________ -----------Rock Size --- ------ ==------------------------ N Distance to nearest: Well ----100_Q--------------------------Foundation -._50.l-------- Prop. Line ..5_"____-_ ---------- REPAIR/ADDITION(Prey:.Sanitation Permit# ____________________________________________ Date _____________ Septic Tank (Specify Requirements) --------------7, .QQ---Ga<1-•---.ept3.e---T-Aiik--&---100-`--L-eaeil- L,3.-23e----------------------- Dis Disposal Field (Specify Requirements) ' p I p Y a } 36 x2. ---------------------------------------------------------- -------------------------- ----------- ----- ------------------------------ -------- ------------ --------------- -- _-_1T _---___________-_______________-_____----________-___-__________________- ------------------------ --------------- _____-____-__________-_ -------------------------------------------------------- -------------------------------------------- (Draw existing an&requi ed.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 following: "I certify that in the performance of the work for which this permit isl issued, hall not employ any person in such manner as to become subject to Workman's Compensation laws of California." '' Signed - , "\-,• -------------------------------------- By BY -------- --- Title ------- (If other than owner) , �, _ FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY - ----------ter--- -`- ��' DATE — Y BUILDING P! RMLT_ISSU.ED �------------------------DATE.----._�- �-�------------------ ADDITIONA COMMEN _ -- - = = = ------------- N --------- - ---------- -------- - -aft, -- - - --------------- - --- ' - --- ----------- ----------------- --------- --- - ---- ------ - Final Inspection by: ------ -------------Date ----�1=1 `�'� - �--^-�------------------------------------------------------------ ----------------------- $AN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 R 5M.