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FOR d:`VICE USE: ; AP}' PLICAT ON 4 FOR SANITATION PERM,f,,IT,. -------•------------------------ ----.. (Complete in Triplicate) Permit, o: �_ .Z.� . R ---------- ------ 3 z 1 Date issued __._-'............... This Permit Expires 11 Year From Date Issued ; Application is hereby made to the San oaquin Local Health District for a per 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 .----- ------ 17201.. ..Road,._.T:Q�'i..........CENSUS TRACT ----------------------- Calvin J. Gr•uneich Owner's Name ------ ----------------------------------------------•------- --------------------=----- ------- -•-•----•-•--• ...Phone _Z2.7-58-13.4............ ) Address 172......._Nor t ..Tu t� ' 014_x., -------------••---....City - 1�.�i7 -C-all.f^rr.!e................................. ___ Contractor's Name ..��a.-T.�s.S:�erL__Si?rAit3 ;nny.--J^-t7.G�.••---------.License# Phone - -3.317i✓4- Installation will serve: Residence FK]Apartment House❑ Commercial ❑Trailer Court 0 Motel F1 Othert..?ifln?B__________________ l Number of living units:-_._2----- Number of bedrooms ............Garbage Grinder ------------ Lot Size _____________________ ............ 1 Water Supply: Public System and name --•----��t 1 ar_.. re.l1----'�._ .._...._-•--.__:........ .............•-•---.----.................Private ❑ k Character of soil to a depth of 3 feet: Sand i p 1],•"`Silt[) Clay ❑ Peat❑ Sandy Loam �❑ Clay Loam,M Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type _______________•--.•-___--__ f (Plot plan, showing size.•ofrlot�,loca,tiorti-Qf system in relation to wells, buildings, etc. must be. placed on reverse side.) NEW INSTALLATION: �.(No septic tank or seepage pit permitted if public sewer is available within 200 feet,) "r PACKAGE TREATMENT [ ] SEPTIC TANK:[ ] Size---- ---------- Liquid Depth ...........................� Capacity l5.Q0. a1_Type GoncxQtQMaterial:_.n _ l,s Compartments No. Com artments ..... Distance to nearest: Well ---------_...................._..---Foundation ...................... Prop. Line ------------- ` LEACHING LINE [ ] No. of Lines . ......... Length of. each line------- _ -.--- 10QLP- _--__ Total Length 100- -........L_ � 'D' Sox ....�__.___ Type`Filter Material3�.�tu.> ..........e::.........•--------------:.....-.Depth Filter Material �_._ �► t Distance to nearest: Well Foundation ........................ Property Line SEEPAGE;PIT r ) Depth -..25.-!D...... Diameter ._._.. Number 2------------------- Rock Filled. Yes No Water Table Depth . .....................••........._....._._....•Rock Size __S;0k2ble........... ' Distance to nearest: Well ........................................Foundation .................... Prop. Line .................. REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ..................................I SepticTank (Specify Requirements) ....... •-•----•-•-- _ ........-•-•-•---•-•-•-•--......-•----•----•-----•-----••-•-----•......................... .•••--........_._._�.. DisposalField (Specify Requirements) ---•-----------------------------•------•----•-------.--•----•-• -----•-----• -:•----•----- ........•-•---•----------•------------ --------------------------- ----- -----------------------------•-•-------- _...------------ •--•----•--•--•--•---•--.--------------- = - (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 wifs San.baquln 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, 1 shall not employ any person in such mann as to become subject to Workman's Compensation laws of California. Signed ._ fh6reth�an n an' action, �iIC. Owner - By .. .._. ...f:.. ! - title . 2'as±�1a?iL:..._...(Iow r) FOR DE MIO&T USE ONLY APPLICATION ACCEPTED BY -.... . ------•----•--- ----- DATE ' -_ ..7 BUILDING PERMIT ISSUED ... •* --- ---------- ............... ---------•--_----- . -...... r r+3". - ; .r-_... X11 "`f _ !! ---. -------------�sv-.tom:-- --. A—,.t�`�•�.�. -------- ----------------------- ----------.. _.... • --- ------•--•-------------- --•--- - ------------------- �l ; Final Inspection by: .. --. :_.. ........ -- -Date ... ..` 1 .� �.. SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'b6 Rev. 5M.