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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT )� (Complete in Triplicate) Permit No. --- -- This Permit Expires ] Year From Date Issued Date Issued --------------- _ ------------------------- -------------- 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: JOB`ADDRESS/LOCATION -----42�k7- -Hieb-bard-- --' - - - ----- '----- a =' mm---- ------CENSUS TRACT ----------- --=-- Owner's Name _.Mr._.McSlay - Phone 9 ..]41�. ---------------••---- Address ---------Same------------ ---------------------=------------------------------------------------- City -----------tQCkt-Qri---------------------- :r--------_----- Contractor's -------_---•- Blaekard'S Septic Tank License # _268.95- 1------_ Phone -;_ F_ .._ A8...._ Contractor sName ---------------------------------------------------------------------------------- Installation will serve: Residence [Apartment House-E] Commercial ❑Trailer Court ;❑ 'tom Motel ❑Other -------------------------------- r Number of living units:------- Number of bedrooms ---2______Garb'age Grinder',, ---- ___,Lot Si e75-' '-X--. ..------------------ Water Supply: Public System and name --------------------------------------------=------------------------ = = ------- -- --- --------Private Character of soil to a depth of 3 feet: Sandf] Silt❑ Clay ❑_ Peet E]'LSgndy Loam •❑ jCiay Loam ❑ Hardpan ❑ 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------------------------------------------------ Liquid Depth -------------._....------- Capacity - -- - ------------- Type -------------------- Material---------- . -------- No. Compartments ------------------ Distance to nearest: Well __________ _______________________Foundation ---------------------- Prop. Line ____----____________- f E LEACHING LINE [ ] No. of Lines ________________________ Length of each line------------------- _- ;.___ Total Length ----------..........___._.-- r 'D' Box ------------ Type Filter Material ____________________Depth Filter Material ________:-______________-___------..------ Distance to nearest: Well ________________________ Foundation_..___.—------------------„Property Line -____._.__._._.___-_._-_ SEEMG644T [ ] Depth __10............. DiameterNumber ----3,---------------- ----- Rock Filled Yes ® No i❑ Sump Water Table Depth ------------------go!---------------.---•---Rock Size ---------.21-''------------------ Distance to nearest: Well ------------------ Q'---------------Foundation ___1 '___-__-__ Prop. Line ...... .............. REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date -------- .---------------------•-) Septic Tank (Specify Requirements) ------------------- -------------------------------------------------------- ------------------------------------------------------ Disposal Field (Specify Requirements) -----------��P_ .'X 'XIQ-'------------------------- ' ----------------------------------- --------- ------------------------------------------------------------------------------------------------------------------- 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: "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner gg become subject to Workman's Compensation laws°.of California." 4 \ Sine°d _ --------11------------Owner BY -- -----B11-1--B_lackard---------------------------------------- - Title 0t1nt c 4r (If other than owner) F EPARTMENT USE ONLY APPLICATION ACCEPTED BY --- =-- --- -/- - -- - - -- - -------------------------------------------------------- DATE -7---------------- BUILDINGPERMIT ISSUED ----- - - ----- --- -- -- -- - ---------- -----------------------------------------------------------DATE ------------------------------------------- ADDITIONALCOMMENTS ------ -------- -- - ---------- ------------------------- ------------- ----------------------------------------------=--------------------------- ------ - - - ---- ----- u. = -- -------- � J— --- - f - - Final Inspection by: ,1� ------------------------------------------------------------------- ----- -Date ---�:1L�r- -. ------�-------- N J AQUIN LOCAL HEALTH DISTRICT '� E. H. 9 1-'68 e . 5M