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r 1 FOR OFFICE USE: ,,.APPLICATION FOR SANITATION P6�IT - --- -- --------- -- -•- .. Permit No7/,.z35 - -------------------------------------- (Complete in Triplicate) o 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: HAVEN ACRES RIVER CLUB: -...CENSUS TRACT ------ ------_--------- JOB ADDRESS/LOCATION .... ---------- -- ...-- -- ----- ------ - - - - - - Owner's Nam Harry BLACKWELL and Audrey M._LILE _ a ----_- _. _...Phone982!-99 __ _ 79..__.. .. .. Address .-- . 69.. ...*- Freyer----Rd ---- -------- Fkk-C' t Lathrop. - Afit At � Contractor's Name .-------Owner doing lyO rk , LiceKse # -- --------:-------- Phone ----------------------- ----- --------------- - --------- - Installation will serve: Residence❑Apartment House F❑ Commercial ❑Trailer Court X Motel ❑Other-- - ---------------------------------- =- Number of living units:_....6__. Number of bedroomk_or...2Garbage Grinder none. Lot Size ----------...--- ---.----------------------- Water Supply: Public System and name ---------._.__W611__OA_propertx -- _.------_---Private IN Character of soil to a depth of 3 feet: Sand❑ Silt[I Clay ❑ Peat❑ Sandy Loam A] Clay Loam ❑ Hardpan❑ Adobe ❑ 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.) NEW INSTALLATION: (No septic tank or seepage ) a e t permitted ifpublics available within 200 feet,l P P 9 P P PACKAGE TREATMENT SEPTIC TANK Size.._. +X Liquid Depth ----- X -- Crete ' p Z ------- C .. apacity�aDbr _hype _._...-__ ateria No. Compartmentst Distance to nearest: Well ----NQ_----------------------Foundation _.-.._...--_-_..,. Prop. Line gY.Cr._50._. LEACHING LINE [ ] No. of ``i es _- ONE_._ .._.:... Length of each line----AQ0--------------- Total Length d1 OQt------------- I X16rr,�cl8n, _ 'D' Box ._--------- ype Filter Material ....ROCk ._Depth Filter Material ...____18��...... V Distance to nearest: Well .300.'------------. Foundation ----- :: :.....::.... Property Line AMCr-50'.__ SEEPAGE PIT [ j Depth ----- Diameter ................ Number _------__- Rock Filled Yes ❑ - No Q WaterTable Depth -----------------------------------------------Rock Size --------------------------------- Distance - -----------------------------Distance to nearest: Well ---------------_-....._.__-............Foundation ..___._.------------ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# .' ------------------------------. Date ----------..----------:-----_----) Septic Tank (Specify Requirements) ---...---- .. Disposal Field (Specify Requirements) ..-____._ _.-----------_...._.-� G /� t��------------------------------------- rA v -- - ----- -- -- -- n ---------`---------`-""' -------'......................----......--- ---------------------------------------------------- =-`'---�- // LTD .._...----------------.............-'f- - -------- ....... - --------------------<._..-'------------•`------'-------=--------------------------------------' (Draw a sting 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 following: i, "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 ct to Work�maa Comm onsation laws of California." Signed ... ---C-- - -V--- / ---------------------................... Owner By .._ .... .... - - ------- --------- _ - Title ------------------ -----------------... (If other than owner) 02 sF�OI�/DL'ARTMENT U�;yE��PjI.Y /�G APPLICATION ACCEPTED B - r r 1 '�" `GP�---`- 1--`---I.--- -- DATE v"Z�3J�7/ - BUILDING PERMIT ISSUED - ------------- - - ---------------------------- ADDITIONAL - .DATE COMMENTS ------------------------------ ---------------------------------------------------------------------------------------------- _------------------------ --------------------------------- ------ -- -.....------... . -------"......-------.......... ................................. ------ ----------- .............................. ----- --- Final Inspection by: ------ --- -- ---------- ------ r --- ------------------------------------------------------Date 7 7 ----- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'66 Rev. 5M `