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' FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 0 Permit No. --.7 9� - (Complete in Triplicate) -------------- Date Issued _��---•S This Permit Expires 1 Year From 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 wifh County Ordinance No. 549 and existing Rules and Regulations: ---------- - --------- ------CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION 9.2'�%_Q_Iff-$�,aTit -�'d.--- -------- - -------- - -- i I---Phone 3l_.-2:09_-462-837,9f Owner's Name C:hAXlga Address 9-290 LTi&ha17t Rd -------- ----------------- City -- ----- -------i------ - --------------- - Contractors NameCB1-7I.83J8>: Phone-91699' . A Installation will serve ResidenceApartment House.-p Commercial [:]Trailer Court ;❑ Motel ❑ Other _'------------------------------------------ Number ------ -------- -----------------Number of living units:-LRl____._ Number of bedrooms -----3--..Garbage Grinder ------------ Lot Size __----------------- -------__________ Private ]Z Water Supply: Public Syste and name ----------------------------------------------------------------- Character of soil to a dep#h of 3 feet: Sand Silt F] Clay E] Peat El Sandy Loam❑ 'Clay Loam:❑ .. a _.- R • _. _ _ t .� - .tines .. _.'.Tq�r rd arr 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.tai'ik`or seepage pit permitted if public sewer is available within 200 feet,) t A ,� ] AL000-L"_ ---------- i Liquid Depth ---57_-!----- ----- �' )PACKAGE TREATMENT [ I SEPTIC TANK' Size___-________�d __.________ % y,f t I ' No. Com Compartments ---�'-----••-------- 9 Capacity__12=00'-- -- Type1x'B—Oast- Material I p Foundation ---- LQ_� __._____-- Prop. Line .TO_t..:........ .. d Distance to r nearest: Well ----11 I-------------- 4 [ r '�' _ Len t LEACHING LINE L ] No. of Linesj-3�_---____ _ - Length of each line__40_--_________-- __-- Total Length ,_ i. 'D�Box. . -'-'r-- Type Filter Material --VC�-----------Depth Filter Material -'--------------------•- ------------.----•- I ' '' �OOt Foundation a 0'-------------- ,Property Line ---]19_!-------•-•--- .,Distance_ to nearest: Well ___________ 6'1E� "Rock Filled. Yes No ❑ 7 SEEPAGE PIT [ ] Depth-2 ------------ Diameter ---36 Number -3------- ---------------!_ [ Water Table Depth ------------------------------------------------Rock Size -----3f to'__61� Distance to nearest: Well �. - ---------- Foundation ---- --Prop. Line lQ................ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------- ---------------------:--) Septic Tank (Specify Requirements) ________________ ____ --------------------------- ------------ Disposal Field (Specify Requirements) --------------•------------------------------------------------------ - -1------- -------------------------------------- - ----•--------------------------------------- -------"--------- ------- ------------------------ I ] --------------------- ------------------------------------------------------------------- u -w ------------- -d- - --- �. - -. . .— - - �-- — --(Draw existing and required addition on reverse side) i, I hereby certify that I have prepared this application and that the work will' be done ini accordance with Son 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, I shall not employ any person in such manner Eas to become subject-to Workman's Compensation laws of California." �al��-tLeBx'tltta --------------------------- k GOwnerBookkee$sl I1q:*--------------------- Title --- T------------- --------------------------- - ------ ----- BY (If other than owner) FOR DEPARTMENT USE ONLY DATE �Q- - - ---- ----- --------- APPLICATION ACCEPTED BY ` DATE BUILDING PERMIT ISSUED ------- -- -------- ----------- �_ ADDITIONAL COMMENTS % ' _ "" `, - -------------------------------------------------------------------------- =--------------- ---------------------------------------------- - ------------------------------------------ Final Inspection b "t��---- ------------------------------------- - ------------------- _Date ._::.' SAN JOAQUIN LOCAL HEALTH DISTRICT (" E. H. 9 1-'48 Rev. 5M "