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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �' .�?.... Permit No. ..... r. -1-1-1-7........... (Complete in Triplicate) c� .................. Date Issued . This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Districtr ce permit rmit t and existing Ruand lesandhe work herein madedescribed. This application is made in compliance with Coy Ordinance o A � �. 3I E Hardin ..c "'*4 ........... ;......3...... .. �� .� , JOB ADDRESS%LO.CATION ; CENPhone D SU5 T A � �w. Owner's Name .....-----•LZ.c:._Shea dnr�:.:...: S tkn. i Waterloo ..I...... City 3030 E. � ........................................................................ .:. Address ..........� � 048 -•- -- I license # Phone ........ ... . ...........r Contractor's Name .Black�:rd...�._.SeP.tic.--�•a�--=--------------•-...._.. -- 26885. Installation will serve: Residence aApartment House Commercial ❑Trailer Court 0 � Motel ❑Other ...............-------------------------- 6�'X100�.........:........... Number of living units:.-�.-:...._ Number of bedrooms ---2-----•Garbage Grinder .........._. Lot Size ..._... ---:•-••.---•••• { Ql_ty•---•- ------------------•---.------ -••--..-_----..----••----•------ .•-.Private ❑ ' Water Supply: Public System and name -------------••- - • - - Sand Loam •❑ Clay Loam Character of soil to a depth of 3 feet: Sand'❑ Silt❑. Clay ❑ Peat❑ Y � Hardpan ❑ Adobe-j) 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 pit permitted if public sewer is available within 200 feet,) - Size--- ��X 'X1n!............... Liquid Depth .... 18.'-'_ ..:..-•--•: PACKAGE "TREATMENT I ] SEPTIC TANK I� I Capacity ;200 -- Type �R! Material-----concretENo. Compartments ...................... .-.��- ..Foundation ...• .......]..... Prop gth of each line...._x QLl'___:-•••- - . line .._15�-••--- Distance to nearest: Well �-""'-_•_ - ' Total....Length _x,0.0•'•......... _..... LEACHING LINE �] No. of lines _.... ................. Len �� 21q 1 - De th Filfier Material _,........................... • -•• 'D' Box ........... -Type Filter Material __......--•••••-•-- p # ' Pro ...�•,--....-•---- �^� � - i Distance to nearest: Well ........ rnt7_._... Foundation -__..- - •---••• Pa Lute . w. - 'umber 1 . . Rock Filled Yes No.(3 Depth Diameter ---..- ,� ------ --- ..:......_ \1 t2tSEEPAGE _a�!' ack•Si : ----g _:Water Table Depth. , Foundation•.i Q_'.' l Prop. Line _....._.3. '._..... .. _Distance to - { .. - � REPAIR/ADDITION(Prev. Sanitation Permit# ............................ ............... Date �_-- �-- ---� 1204-_.Cx ------------ -- Septic Tank {Specify Requirements) ................... j ~- r Disposal Field (Specify Requirements) 14-Q-'-...Leg.ah_..L ne..&---(•3 -__P3 t... 6.'-'.X2r3� �`;' # i - " � ..._....__.•.............................................��-�-SFT--f_.._.»....._.....__.....-_-•d r�. .... ...........................I------ -- «................ -- ----- ...................I...... F ..:. :----•-•-----------••------•---••....... .......... (Draw existing and.required addition on reverse side) I-hereby certify that have prepared this application,cind that the work will be done in accordance with San Joaquin I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or Bean- sed agents signature certifies the following: °:1 certify that.in the performance of the work far,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. ' _ .. . Owner Signed -------------------- ..... ........_...... 0 . -- •.... ..... ......... C gntractM or _...........------•-- E i + # J (If other than owner). ; 1, OR TMENT USE,ONLY t� I ._.... APPLICATION ACCEPTED BY --•• _ :BUILDING PERMIT ISSUED::. )F �" •- _ _ DATE 1 •' t _• •... ....•.............. :L........• ..................... •....._.._..;_... t ' ADDITIONAL COMMS 1f •. •--•- ..... .. . --•-•-•---------- ........... ........ ••. -----• ----------------------- R ........- ...r.. ...... ....... .. ......._ .._ ....... `..........-•-..... Date ... 'Final Inspecti by: ----•--------•...:.................... i JON LOCA_L HEALTH DIST .