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KRA OF FICE USE: " APPLICATION FOR SANITATION PERMIT . - ................ .. --- (Complete in Triplicate) Permit No. .._7T. ....... - -........ - ..... This Permit Expires 1 Year From Date Issued Date Issued _.3. .....:7.. Application is hereby made to the San Joaquin Local Health District,-for afpermit 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 ....---•---..... 2482._Car-Denter -Ad .— ................... .::'CENSUS TRACT --------......_..----- ......`---- ---------•- .-..... Owner's NameTo-mm y WililamS.. Phone 46",42-3-9 f Address ---_....9q,gi!'.................... .......... .... . ......'.._. . _..... .. City -/S tkn Contractor's Name A-R1ae1u3T'd_'_a_-Septie...`I'`*nk. . _ _..Licensee ...25$951------ Phone _46.31-.7o4.8...... Installation will serve �' 1j ResideAce ❑Apartment House❑ Commercial bTrailer Court ❑ ( I Motel ❑Other .................................. ) Number of living units:..g;r 1 Number of bedrooms . .5 --.Garbage Grinder Lot Size ....... ...... Water Supply: Public System and name'----------------- - --- _............ --••----1--...' Private _ - ---------------- Character of soil to a depth of 3 feet: Sand,C Silt❑� Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ '• Adobe K] 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-permitt d'if-public sewer is available within 200 feet,) PACKAGE TREATMENT .1 J SEPTIC TANK-[ j Size-` Liquid Depth ..... ......... I Capacity --- Type ------ -----_7--- -Material.'...'- No. Compartments Distance to nearest: Well .............Found atiori-:__. Prop. Line ----------------------)J LEACHING LINE pc] No. of Lines 1 Length of each line.. 9Q.-....--_.-- Total Length __.90 r ....qr- 'D' Box],..... Type Filter Material .... .2. Filter Material . .........1.q"................. ' + Distance_to_nearest..-Well.:_.._.-. R0._I Foundation..........'. . .._ Property Line .._801 .........--- SEEPAGE PIT [ ) Depth Diameter _._... ......... Number ........ ...... :. ....... Rock Filled Yes ❑• J No iC t t Water Table Depth ..--••.....................................•----Rock Size .. '..........._ (P . iDistance to nearest: Well ............... .__...--Foundation ° Prop. Line ----------- REPAIR/ADDITION(Prev. Sanitation Permit# -------- ------------------------------ Date --------A].i9.....7.2_.___._) Septic Tank (Specify Requirements) - ••- -��-- -•--- ---------�:.. __.... ................................. ...... .. ` Disposal Field {Specify Requirements) ....00�. .Leach L ne. ' ---- tr V. .............. ................... .................. ................I............. ..... ......... .. . - ..................... ..... ............ �......_.......................- ......•........... . ................ ........................ . .......... .......... J F (Draw existing and required addition on reverse side) I I hereby certify that 1 have prepared_tWis appGction and that the work will be—done in accordance with Sarf 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 the work for 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." 'Signed i � -------- -------- ...... ... By -'- CLe- ...... .................... . caner .. Title -- ------COntrp ctor ............... ...... ---------- r (If other than owner) ; FOR DEPARTMENT SE ONLY APPLICATION ACCEPTED BY ------------------- .-- ..__.--•-••--•-- :-..._._•._..�__ . r DATE / ------ BUILD.IVG.,PERMIT.ISSUED ..... - .. , : ........... ..................... :..------ ADDITIONALCOMMENTS __ -.-...................................................................................................................... . -- --------................ .......... ............. . .............................................. --• .............................................................. -------- --------------- -• ' Final Inspection by; ____....... .. . ........... . . ..Date .... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M