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`? -AOR OFFICE USE: APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No: ---712_7'_/!._-� --------------=------------------------------------------ -______________________________________.---------------IThis Permit Expires 1 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 ap lic9tio ismadelin compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRE.SIb8r'ty__Rd._�/8---mi-le--1 ---O_f-_ qty 9-9)-------------�----CENSUS TRACT -------------------------- Owner's ---J-�-�------------ Owner's Name Loren_ ferry---- -=- ----_- -----.Phone._3C-8--_9✓136------------- Address 21- - tTB----- Zane City -hdi-- --------- - ---t-916-}----------- -- --= -- -- -— Contractor's Name -Gal.-?yes ter'nrSani_tat,ion,_;jpC._. I$J.784., .� 483-84'71 t - License #Y _ .. done --------------- --------- Installation will serve: Residence-g-A-partment•.House,❑-Commercial-:]Trailer-Court -0- - .Motel El Other *' ------------------------------ Number ofliving units:___- _____ Number of bedrooms` 3_.°_ ar age Grinder ---------__ _ Lot Size ___98 x 218- Y ti f t I - Water Supply: Public System and name ---------------- ----------------- --Private [� i Character of soil to a depth of 3 feet: `-Sand'❑_. .5lJt❑ dlay, ❑ Peat❑ Sandy Loam❑ Clay Loam:❑ - {- - s Hardpan (] 1 Adobe--E] 'Fill Material ----- ------ Ifyes,type ____________________________ (Plot plan, showing size of lof ;41ocation 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 204 feet,),,; �f PACKAGE TREATMENTt»-----x y. [ � SEPTIC TANK kj -- 'J Size------mound-_-11 ------- ---__-- Liquid Depth -------------------------- i Capacity 15.00--------- TypeFl-b-o 'g-laZAkaterialFIlaer'glaallo. Compartments J------------ Distance to nearest: Well ------------------------------------Foundation--------------------- Prop. Line ------____,_. LEACHING LINE 1�-] No. of Lines __._�-___.__________ Length of each .line------- _:__-______ Total Length ,_ -_ ------ 'D' Box tcryvc _'- Type Filter Material __; ______Depth Filter Material -------- ---------------------- Distance to nearest: Well _-,�"�_`__�+'_______ Foundation __- ''_-___- _. 'Property Line __ _--y.-------------- # j` SEEPAGE PIT Depth ____ Diameter ______ _________ Number -----.'Z------------_______ Rock Filled Yes, ' No i❑ Water Table :Depth ------------Size _ 'r Y------------' Distance to nearest: Well ---------------------------Foundation Jam_`--------- Prop. Lime ___ ......... REPAIR ADDITION(Prev. Sanitation Permit# -------- ' Date / - ---------------------- it: '77 .._ T" _ _ -- Septic Tan (Specify Requirements) .---- --- ------------ ------------------------------------- - DisposalField (Specify Requirements) -- ---------------------------•-----------------------------------------------•----------------------------------------------------- 1 ------------------------------- --------- -------------------------------- ------- - --------- -------------------------------------------------------------------------------- (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 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 subjeet to Work' 's Co�ipensation laws of"California.'=- _ _ F Signed .. • x'.Xl_ ails, at 1t1C owner _- ------- --- B ------_ President Y - — ----------- ------------------------ Title --------- ---- ---- ---------- ----------------------------------------- (If ober than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... �'�'�"-tr ----------------------- ----------------- - DATE / - } BUILDINGPERMIT ISSUED -------------"-'---------- -----------------------------•-----------------------------------=--------------DATE -------- ------------------------ --•------------------ i-----•--- ADDITIONAL COMMENTS .------- --------------•------- ------------------------------------------------ ----------------------------------------------------------- ------------------------------------------------------------------- ------------------------------ ------------------ --------------- --------------------- ------------------------------------------------------------------------------------------------------ t - ------- p y - - ----------------------------------------------------- �_ ---------------- Final _ Inspection b _-- -------------------.Date - --___-"� _ ` �` � { SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 . 1-'b8 Rev. 5M