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. FOR OFFICE USE: ' ,. "'''PPLICATION FOR SANITATION PER ----------- ------- ------ Permit No ___ _1--�/f/- . - - - (Complete-in Triplicate)— --_ :.. _ _ -_ _. This Permit Expires 1 Year From Date Issued Date Issued --- f�C1 Z f ; Application is hereby made to the a 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: 14�Q1,...E, Co.. er JOB;ADDRESS/LOCATION . 7 --- - gPa} -------CEUS TRACT __. tv Owner's Name ----Mrs___atar_k----------------------------------- __q- ------------• 7 � 3S` bone . 462-1-012 Address Sams= - ------------------ ------ -----------------• --------- =--:-: City S- kx1. ------------------ ---------------------__---------_------- Cant ractor's --------------Contractor's NameLlackarE '-&----=----------------------------- License. #2�0951----- -•-- Phone ---463^70-48_..... Installation will serve, Residence M Apartment House[ Commercial:❑Trailer Court y. Motel ❑Other __Mob:1-1-,-H-orae---------------- NumbeNumber r of living units:--1_____--_ Number of bedrooms _____2-----Garba_ge Grinder ------------ Lot Size ----_2_karez---__________________ Water Supply: Public System and name ______________________________ ------------------------------------------ __-.Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam❑ Hardpan ❑ Ad6be:[3 Fill Material ___________ If yes,type ____--------------------------- (Plot, __ __________________ _(Plot'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 pyblic sewer is available within 200 fest,) 1 -- n _ PACKAGE TREATMENT [ ] SEPTIC TANK-iC] -Site------�'-,��+-�lfl-�-------------______ Liquid Depth -----4_8_... V Capacity --120.0------ Type meq; Material----- CPT1IPX!G o. Compartments -2.............. O , Distance to nearest: Well __:E . _ -- - r--------_------Foundation _1Q'.......... : . :- Prop. Line -1_ "_!---=-------- LEACHING , LINE �] No. of Lines 1______________________ _Length of each:line__-_1-p�+_______.__'_-. Total length ____�d�------- 'D' - __'D' Box ------------ Type Filter Material .-------- "-------Depth Filter Material' ---------1_9' Distance to nearest: Well _____ ___--Foundation _20_'________L___L___.,,'Property LineloD A_________________ SEEPAGE PIT [K] 2_ �1 Depth }-- ------------ Diameter ..... Number -]_------------------:____- Rock Filled Yes ® No ❑ � Water Table Depth _____-__ 9a ' �--------•-•-------------------'_-Rock Size -2�}----•-------- ' Distance to nearest: Well -------3---1 0 9-•----------- Foyndati.on, ---lp( --.-•-- Prop. Lines------- REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------- --- Date --------------- ............ Septic Tank (Specify Requirements) --------1_20 a10 - ----------------------------------------------- ------------------------------------ Disposal Field (Specify Requirements) ---10Q 9--_Leaoh--L1ne- Pit------------------------------------------------------ - ------------------------------------------------------------------ (Draw�existing and � I hereby certify that I have prepared this application and required athatthe wreverse ok w o ll be side) na e in accordance with San Jo - -_- , Joaquin x 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 is issued, I shall not employ any person in such manner as to-become subject to Workman's Compensation laws of California." Signed ------------ - -- Owner r/ BY - = Title - (If other than owner) FOR DEP RTMENT USE ONLY K APPLICATION ACCEPTED BY 4 ------------------------- - --------------------------------------------------------- - DATE S �-�--- =------ BUILDINGPERMIT ISSUED -- ----------------------------------------------------------------------- --------------=--------•----.DATE -----------•-------------------- _------ ADDITIONALCOMMENTS --------------------------------------•--- -------------------------------- ............. ----- ----- ------------- ------------I---- - ---------------------------------------------------------------- ---------- ------ ---- ----------------------- - Final ';Inspection by: ------ --)------ :-- _ Date SAN JOAQUI LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M