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FOR OFFICE USE: APPLICATION FOR SAblITATION PERMIT ------- ------------ ; ., Permit No. ' (Complete in Triplicate) - ------------------------------------------------------------ _ Date Issued __�=---�----� - ------------------------------ ------------------------ I "" This Permit Expires 1 Year From Date Issued 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: x South East, corner of Holt Ad.&GhI 6l-CENSUS TRACT _____.._------.----------- JOBADDRESS/LOCATION ------ 7-=------------ ----------------------------------------------------------------- Owner's Name Vita Peat '.Co. ----- ----------- Phone �' 6 7D Address ----Same-------- ---------------- i-------------------------------------------------- ------------ City -----Hol-t------------------------------------------------------------ Contractor's Name ---BlackardRs- __--___-________.- :--License # __26895.1------ Phone �63�-_NO-_------- ' _ Installation will serve: Residence F-1Apartment House Commercial :❑Trailer Court l❑ Motel ❑ Other _-:Mobil--Rome-------------- J � Number of living units:---_].__-- Number of bedrooms°_ --------Garbage Grinder ""."` ---- Lot Size ----N__Aeres------------------- Water Supply: Public System and name - _.---------- j -+-------------------- ------ ----Private El Character of soil to a depth of 3 feet Sand'❑ Silt❑ Clay ❑ Peau] ..Sandy Loam -❑ Clay Loam '[] �1Hardpan ❑ Adobe'❑ 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,) PACKAGE TREATMENT [ ] SEPTIC TANK [ Size--------41XV XIO I----------------- Liquid Depth -1¢-g-tt------------.-• -- 1200 ga1T Sq-'--------- Material--- one 'e eNo. Compartmenfis -----2---_-------- Capacity - - ----- ----- YP a Distance to nearest: Wel! -----T1On-e--------------------Foundation ---10-'------------- Prop. Line --------1-,0.0Q- 1 t Tota! Length 1 0' LEACHING LINE *3 No. of Lines --2------------------- Length of each line--------- a I- 2 e.------ Depth Filter Material b' Bax -----� - Type Filter Material ---- ................. P ------Z.�-------------------•-----------Distance to nearest: Well t - Property Line ---_I-40II-------- ___]?S2TO_.___ Foundation __2A____.--------- a SEEPAGE PIT [ ] Depth ..__';_�-------------- Diameter Number ---------------------------- Rock Filled Yes ❑ No 0 y -------------- - WaterTable Depth ------------------------------l0 `------------------Rock Size ------za--------------------- r Distance to, nearest: Well --------------------------- ---Foundation -------------------- Prop. Line ----------------•----- 'I F REPAIR/ADDITION(Prev. Sanitation Permit# ---------------------------------------------Date ----------------------------------) ri Septic Tank (Specify Requirements) -------------------- Disposal Field (Specify Requirements) --------------------------- s - ------------------------- ---------- a ----------------------------------- ---------------- --------- ------------------------------------------------------- -------- -------------------------------------------- ,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 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. "I certify that in the performance of the work for 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." j Signed ---�-f = Owner Sfl�c. . Title By ------------- (If other than owner) F DEP ENT USE ONLY DATE APPLICATION ACCEPTED B BUILDING PERMIT ISSUED ------------------------ ------------------------------------------------------- ----------DATE ------------------------------------------- - ADDITIONAL COMMENTS ------------=--- ----------------- ___-___.__,__ .__.___ __.- -_---------------- ---------------------------------------------- _-------------------------------------------------------------- ----------------------------------------------------- �--------------- ---------------------------------------------------------------------------------------------- ----- ---- ---------- ------------------- -------------- ---- _ --------- ------------------------------------------------------------------------------------ - ate Final Inspection b JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M