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'OR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� .... (Complete in Triplicate) Permit No. 77/. Date issued .. ..�............. ................................................I........ This Permit Expires >I Year From Date Issued ! 4 Application is hereby made to the San Joaquin Local He for a permit to construct and install the work herein described. This application is made in compliance w' County—Or in , 549 and existing Rules and Regulations. 9./3 / JOS ADDRESS/LOCATION ,....:,.....31hj tet-H0o a�.P._,. Liar-i-has .-.A ..............CENSUS TRACT .__._..--:........._..... r Owner's Name ...... ! ...C.oia.s in*at1-©n........................................................................:.........Phone..................................... Address .-._...__. 3. . j'" C]7 Cr._Kay............................:.............. City ..........j5tkia ............ ................. a Contractor's Name ' lords`.�..��pt�-�•. Wank.-•-----------------------------License # :...258.95�1 --.._ Phone .---•- 6 7948-.. Installation will serve: Residence-0 Apartment House El Commercial flTrailer Court 0 Motel ❑Other ............................................ Number of living units:............ Number of bedrooms ____Garbage Grinder ............ Lot Size ....-�...a .......... Water Supply: Public System and name ................................. it-y-------------......................................... .............Private ❑ Character of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ -Peat-C] Sandy loam •❑ Clay Loam D Hardpan C❑ Adobe Q Fill Material ............ If yes,type ............................ s (Plot plan, showing size of lot, location ofsystem 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 t]3 size..._R�.':X6'16.1..................... Liquid,-Depth _...._.48.'.'...,•--.....Capacity ....2400I-.... Type ...._..sa....... Material—.....cmnc_re�. Compartments ......2_ . Distance to nearest: Well ..�.:-.�- r.:,: Foundation ....._. d° � ' ..__..._._ Prop. tine ......�.............. i LEACHING LINE No. of Lines ..2_................... Length of each line--------7.00.1............ Total Length —.2001—........... V -_.200 --:._.--...--- 'D' Sox ...I------- Type Filter Material .........2_"_....Depth Filter Material ..........1.9!!........................... 60 r , Distance to nearest: Well :"':'_"'"'" .:.. Foundation ____ ________ __... .__.____._ Property Line .....__..__7�.._...._. SEEPAGE PIT PC) Depth ........_5__'..__.. Diameter ....4.8....... Number ... ...............:.... Rock Filled Yes 13 No • Water Table Depth p".:..::.:.::::.......Rock Size ...... A� Distance to nearest: Well _._._.Foundation r Prop. Line ------------7.5.. REPAIR/ADDITION(Prev. Sanitation Permit# ..................:......................... Dote ................................... ) Septic Tank (Specify Requirements) ..........2.4ag... a�a---------------------------------•----......................... .......... ...._.---- ... `� Disposal Field (Specify Requirements) _.. 00f Leach Line- &-- ;'_2_ .._P -5...? _". 2 .'........................ ... . J - (Draw existing and required addition an reverse side)`�M 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: , r "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," �' 1 Signedg .............................................................................................•... Owner B Contractor Y ------ ----------•- Title .----..:_......---= - (If other than owner) I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-..-..- :... DATE.... L ............ BUILDING PERMIT ISSUED ................ -------------------- ..:----•.........................'...............DATE ........................ -•--•-------•-------- !-------•-•--_.... ADDITIONAL COMMENTS ;�. ...-•---•.........................•_..........---...........-•---._.............. .....................................................••••------------••---•.:................................................... ............................ ----••-----------•_...............--=-------...................._-•---.......__----•-----------..................._...-.._.---•------••---._..._........................... ............................•oi?� ...... -•--------------..-.......................-.............--•-•-------......... .....Final Inspection by: Date . �� r ......... t SAN JOAQUIN LOCAL HEALTH DISTRICT • 3-3 E.- 24 E:H. 1-'68 Rev. SM 7172 3-M