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FOR OFFICE USE: e ICATION FOR SANITATION PERMIT ..... ...ZoAPPI . 1. _...I - IK I/- Permit No. .......... (ClomplotJ in Triplicate) ......................................................... ......................................................... This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the Son Joaquin Local Health District for a permit to construct and ins!all the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: tockton -T JOB ADDRESS/LOCATION 3?90 �Torth 14ilson Wab....F..............................CENSUS TRACT ...... .......... ................................................ ... Owner's Name .......................11ilan-A,.—Farrish..................................................................... Phone........)166.3.607.......... Address ........................... ...................... .................................... Contractor's Name .................... r....... t__._._____...License# ......10.05 ..... Phone ............ Installation will serve: Residence 0 Apartment Houseo Commercial ]Trailer Court 0 Motel r-1 Other............................................. Number of living units:............ Number of bedrooms ............Go,ba.ge Grinder ............ Lot Size ..............• - Water Supply: Public System and name .......... ..................................................................................................Private Character of soil to a depth of 3 feet: Sand 0 Silt C1 Clay E] Peat 0 Sandy Loom 0 Clay Loom 0 Hardpan M Adobe EJ Fill Material ....Yes..if yes,type (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) (41 NEW 114STALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK D* Size....3X5?0..............................-- Liquid Depth ........5.2 ...... al...fQnqret0.. No. Compartments ....TWQ... Capacity ...12 0. ...... Type ... Materi ......... Distance to nearest: Well ...... .......... ......................Foundation...... Prop. tine...1PT....... LEACHING LINE [q No. of Lines .....QaO............ Length of each line........60................ Total Length .....AQ! .............. 'D' Box nre.c.a.sfype Filter Material ..1!!712qK Depth Filter Material ........1.9!.....-.....•.................. 1 oot Distance to nearest: Well .....90.............. Foundation ...2....0................ Property Line ..l...................... SEEPAGE PIT PC] Depth ......... Diameter 33........... Number one.................... Rock Filled Yes t] No [3 Water Table Depth ........6..o.., ...................................Rock Size.......5% Distance to nearest: ........................ Well ......;��0.1..........................Foundation A91............. Prop. Line .... .......... REPAIR/ADDITION(Prev. Sanitation Permit# ....... .................................... Date ..................................) SepticTank (Specify Requirements) ......................................................................................................................................... ................................................. Disposal Field (Specific Requirements) ................................................... ............................. ... ........................................... .......................................................I................................................................................................... (Draw existing 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 Son Jo"U County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Home owner or Ilcon- sod 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 man W as to become subject to Workman's Compensation laws of California." Signed ................M i le s_1L....P.a r ri s s.... / . 7 ............ Owner ....... I tle ........................................................................ By.................. 4�f&&k�',e- than than owner) FOR DEPARTMENT USE ONLY .................. APPLICATION ACCEPTED .............. � k............................ .................... BY.......W ..5... .—. DATE BUILDINGPERMIT ISSUED ........................................................................ ...............................DATE........................................... ADDITIONALCOMMENTS..................................................................... ...........................................................I........................... ..................................................-...........................................................................................................A............................... ........................................................................................................................... .. ......................................................... -- ----.---------- -- --b--. . ................ ......... ............................... .......... .......... e,.... . .......... Final Inspection y ......................... ..Dote. ... . SAN JOAQUIN LOCAL HEAITI DISTRICT E. H. 9 1-'68 Rev. 5M