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ffJ9 OFFICE USE: T APPLICATION FOR SANI'T'ATION PERMIT 1 9 5 #Camplata In Triplicate) Permit No. ...� /�� ""'- ...................• ............ This Permit Expires I Year Frown Date issued Date Issued _a_,aA7n7.- 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/LOCATIONCEN5U5 TRACT _.._.................... . Owner's Name ....... 5'at1 .. r>d.,A -ce.. �l .c..�to ...............Phone 9B -mo799 Address .-----._._.11 .-- _.. .....99..H WWa,Y..:-- M t•eca�..... c►tY _Maan eCa ......... -------- ..... ......•--........._._.....-- ............ Contractor's Name _°P_ay�Lee'!.-Septic .Tank Service - ------ ---------------------License # 261.73.7----••--- Phone' 65!!87$5 Instolfation will serve: Residence®Apartment House 0 Commercial❑Trailer Court � Motel ❑Other--- Number of living units:---1-------Number of bedrooms ---3.......Garbage Grinder ..n�_---- Lot Size------... ---sere Water Supply: Public System and name ... e , oa o Y►r neT'y (�s04Q-»f t;- away - _Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay 0 Peat❑ Sandy Loam (2 Clay Loam Hardpan ❑ Adobe❑ Fill Materlal ............ if yes,type............... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) T NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK ............... Liquid Depth .......................... ------------ Capacity -------------------- Type ------ ••----------- Material---------------------- No. Compartments _._ ................. Distance to nearest: Well --••-•------- --......Foundation .--------•--------- Prop. Line ....................... .............. .. r [7� No. of lines .�__-. ACHING LINE -.---------. Length of each line.... �0t............. . Total Length ...N. .._ . 'D' Box ..,[819__ Type Filter Material -.rQGk........Depth Filter Material ...18«---...... VI Distance to nearest: Well -JL0 0()-f_._....._. Foundation 10=...PIRA--- Property Line N SEEPAGE PIT ---- Diameter ............... Number .......__......_........._.. Rock Filled Yes ❑ No (:)Water Table Depth ............ .............. --------------------Rock Size ............ --------- -1 10 Distance to nearest: Well .................---•-•-----------......Foundation ------------------- Prop. Line ..............------_E REPAIR/ADDITION(Prev. Sanitation Permit# ------------------------------------------ Date ........................... Septic Tank (Specify Requirements) .............. ........................................I.....•. Disposal Field (Specify Requirements) ....................... ---- ---------------------------------------- ----------• .. ............._-.._-----_.__..---•------- -- (Drnw existing and required addition on reverse side) 1 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 subject to Workman's pensatio 'laws of California." Signed -------•---- -- .--- Owner By -------- ---- --- [ � •�� hon r) a 0. Warthari Title .Contractor... F R DE ART T U E ONLY APPLICATION ACCEPTED B .__ ----- ------------------ --- - ---- -- ---- --•------ ... DATE ... --.Z.7_-_>-� ----------- BUILDING PERMIT ISSUED . --------••----------- ' ADDITIONAL COMMENTS _____________________ -...---------------DATE ------------------- -----•----------------• ----...._. ........ -----------.._- ----- --------------------............I....... --------------- ------------ --- O -------- ------------------ Final Inspection by: .._-- ....... Date .-- ... . ---!_ --_--•- --------- EH 13 2h 1-68 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M