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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ..7 -3...... s ........................................... n I This Permit Expires i Year From Bata Issued Date Issued .Ss..r 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 N.....s. .de of: Gawne Road appx. 2 mi.Wof Es c� S 1�•��t a •.................. -----.....---............- ..............,. Owner's Name ......f..John Haz and .............................••--------•-----------••---•--------------•-.•..............:............----••-• --Phone ........._........ ........ 7500 Meadow_ - M. Address ..�....-•----•---------.'-:.atm••�i.a©�te�---S•ewe�..S.es:..---------------------License # .-2.7 -.��-9....:-. P...:..---.......---•---.....:...._...:. --------...................... Contractor's Name }� 1 honelk65-2616 • ......................... In'stailation will serve: - Residence Apartment House fl] Commercial-❑Trailer Court 0 ' Motel ❑Other Number of living units:1-_--..-... Number of bedrooms -.1.........Garbage Grinder yea..--. Lot Size acre.?-R ......................... Water Supply: Public System and name ---------- ------------------•---: .:..........-•-•-------.....•------------- --------•......................:...Private ® e Character of soil to a depth of 3 feet: ' Sand❑i . Silt❑ Clay ❑ Peat Ej Sandy Loam.❑ Clay Loam ❑ ; Hardpan.[] Adobe Fill Material --.---...... If yes,type .............. ...... k � L (Plot plan; showing size of lot, location of system_in relation to wells, buildings, etc: must be placed on reverse side.) NEW 1NSTALLATIONC (No septic to'ik or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ]s SEPTIC,TANKtK]`, S4e.X--5_-X- 9Liquid Depth ................... 1200 pre cast concrete 7 t Capacity = ............•-• Type------- ----.._ Material---------------------- No. Compartments ................. f . . - Pro Distance to �near]sts`'Well',,...-._.. . �.. Zits.-..Foundation 10.1....... ..... . Lines 1.___..... ..... ' . ----------- - --- ------ Len th of each line.-._g0-_ - . Total Le pth ------------ no -_9��_...-.--•---:..... �(1� LEACHING LINE � �] No. of Unes . - g .. 'D' Box .....-.]:° Type'Filter Material ..rock-______.Depth Filter Material ._-�......._-_. -----••................•-•- Distance to nearest: Well 10Q t...':_:..----•'`F,oundation ..10.!............... Property lane 5.'...........•.......... SEEPAGE PIT [ ) Depth ........ ......... Diameter ......:......:.. Number .-.--------................. Rock Filled Yes ❑ No C Water Table:Depth' Rack Size _........... --•--•...........................•..... --••--.. ........... REPAIR/ADDITION. Distance to nearest: Well ...... ...Foundation ..................... Prop Line.. I (Prev. Sanitation Permit#` ...................._--_.................. Dote ...........:.....----------•...... )� Septic Tank (Specify Requirements) _:.:..-.... .............................. ..:...._...=.. ..... ........_ ;Disposal Field (Specify Requirements) ............... �. .......s e ... -------------------------- - --------- .............................................................. -------------------------------------...................................•...................... (Draw existing and required addition on reverse side) 1 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 We work far which this permit Is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ................ ---- Owner .......................J'Q.Q. Tmai:�Q- :-.., title Contract_ or (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-11 -...-.. ." :.. ....................... DATEJ......F....-:...=..7 .. BUILDING PERMIT ISSUED ....... =` = --------_•---•------:_:............. DATE .:. ADDITIONAL COMMENTS ., ......................................................................-........................................•----------•----•--------- ............................•--.... .. ---•----------_---•-•........--•--..... ..... ............................. -------------•--- ------- .--- .................................................... ............................................. :.... •....... ---------------- ._...........--------. Final Inspection by: ..__ :.f .........................---•------------....;..Date .....s -': �. ., J I SAN J AQUIN ?LOCAL HEALTH DISTRICT t E. H.13 24 1.'68 Rev- SM 7172 3 K k