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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �� Permit No: i (Complete in Triplicate) ------- --------------------------------------- .-k ---- °� I ''e'�. \. „� Date Issued .� �, _,___. _d. � ... . —'This.Permit.Expires,l.Year_From..Date Issued ---------- 9 Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulation,s: JOB::ADDRESS/LOCATION : 53a3l-E... Marsh----- --------------- --•------------- --------------- ------CENSUS TRACT ' ----------.Phone ----46-5-773,9 OwnerOwner's Name .--` -MTs_,.--MCGu3.-x'e, =_=-- ----;--------•---------------------------------- -------- 's ____.- {{ y S - 2689,53 . ------------------------------------- - - - Address ----__Sale ---- -----•-- - - --- , city t se # 2689 1_----- Phone 6_3�� 7_Q48BlackrVsSe tic Tank ---------- -------Licen --- . Contractor's Name --------------------- ------------------------ ------- - eInstallation will serve: Residence-E]-Apartment l! House.,[] Commercial :❑Trailer Court iQ f Motel ❑ Other --------------------------- ---------------- I . Number of living units:----- Number of bedrooms __2--------Garbage Grinder ----------- Lot SizeAH-'X10-0-1-------------------- F I Y Peat Sand Loam Private ❑ .Supply: Public System and name - -Cid' --------------•---- ----------i----------------- --------------------------------------- Water Character of soil to a depth of 3 feet: ; Sand'❑ 5ilt[] Clay ❑ ❑ y ❑ Clay Loam ❑ !'Hardpan ❑ Adobe'® Fill Material ------------ If --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.must�b'a played{on reverse sde.l w NEW INSTALLATION: (No septic:tank or seepage pit permitted if public sewer is available within 200 feet,) 4X415 11X10F' ------- Liquid Depth ----= n PACKAGE TREATMENT ( � SEPTIC TANK�I Size-------------------------------------- q p ,.. Capacity'1-120-0 -9allype sq�---------_Materia eMl i ------ No. Compartments _,--2---------------- 4 , Tim IFoundation - Q --- Prop. Line '---1-04a Distance to_nearest: Well 1!r ' " LEACHING LINE I[l nes------1- - -- --------- Length of each line--------1Q(�-t-- ------ Total Length -l-0 ':y------------• i No.wpf_Li I Filter Material ---?I* --_ I*-------•----Depth Filter Material ------------1-9'-'-------'-.•-------`I....... D' Box --,,Type2 Distance to nearest: Well ---------------------- Foundation -------2Qi--------- Property Line SEZpr�t. �] Qepth ___ 1.0'1' -R--- Diameter 8_1_X A---- Number ------------1-------------- Rock Filled Yes ®N No �❑ 4 Y ��'Table Depth ------ ��a-s------------------=---• Rock Size 2�' E .� Water Ta 1 ( I - -_ --------Foundation ---- '---------- Prop. Line =_------------------ t � Distance to nearest: Well -_____---_.�.-_____ ___ 50-- REPAIR/ADDITION(Prev. Sanitation Permit s# -------_--------------- 'Date ------------------ ----- ) ------ ---------•--- ad_.�_ 1 ==: ------------------------••----------------------- Septic Tank (Specify Requicemenis) `,�_£-_�;-�F-`1 -2�.00__ G , Disposal Field (Specify Requirements) ---100-1----Ljea.ch-1-L.ane•-�&---Sump---4-'-X8"-X-1at------------------------ ) r ° 1 l ------------------------- ------------------- ---- ------ ______________________ _._A__.__. .._ __ _____________________________`---ti________-____-_______----____ (Draw existing and required addition on reverse side) jl hereby certify that I have prepared this..application and that,the work will be done in accordance with San Joaquin f County Ordinances, State Laws, and Rules'arid 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, I shall not employ any person in such manner k as to',become subject to Workman's Compe sation laws of CaiiFornia." ----- ------,----_---- ,•- .--- Owner_"`. Signed ------- ------ ----------------------------------------------------- --------- `' Title + ------------' i 8Y :_ F (If other than owner) i FOR DEPARTMENT USE ONLY --�! 5 / ----- ----------------------------------. DATE APPLICATION ACCEPTED BY -./------ --- -------- -------- _ ' BUILDING PERMIT ISSUED --------------- DATE i ADDITIONAL COMMENTS --------------------------------------------------------------- ----- ----= - - - . ---------------- ---- ---- --- ---------------------------------------(/ - 4 __________ _______________••--_._______-_________-----------------------.------------(—-_ -------- -_.�/ ------ ----------------------- to Final Inspection by: . - - t SAN JOAQUIN LOCAL HEALTH DISTRICT E E. H.'9 1-'68 Rev. 5M