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FOk OFFICE USE: APPLICATION FOR SANITATION PERMIT - Perm°w No, 7,3_ / _W .._ . _ - 'C mpl Tripl' tel--- --- - -- . ' --------- ------------------------------------------------ � Date Issued � 7 . - ---------------- --------------- -------------------- 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 with County Ordinance No. 549 and existing Rules and Regulations: .JOB ADDRESS/LOCATION .--------------- 23--,3czr---uink1eY-------------------------------------- --- ----- CENSUS TRACT -------------------------- Nr, Lancaster ---------Phone -----464..9661-------_-- Owner's Name --- - r - ---- � 7 - `oo• I k ay -------------------------------------------------. City ------5t1m---------------------------------------------------------- --- . Address __._ _ _ 463.-7U48 Contractor's Name Rla aG 'a rd_'-_s_..S_e 1t-3 G nl< -----------------------.License # 26.8-9-51 Phone Installation will serve; Residence] Apartment House,❑ Commercial ❑Trailer Court ;❑ Motel ❑ Other ------------------------------------ ------- - E Number of living units:---1------- Number of bedrooms -----_2_•_=-Garbage Grinder --- ------- Lot Size ----___5.0-OX-1-55V_______________ Water Supply: Public System and name ----------------- 1 Clt _ ` -_------Private ----------: y------------------------------------------------- ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑] ' ody ❑ Peat E-1 Sandy Loam ❑ Clay Loam E] Hardpan ❑ Adobe aFill 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 tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK![ ] r Size_`_________------------------------------------- Liquid Depth ----------- --------------- Capacity Type -',Material---------------------- No. Compartments ------ ----------- N Distance to nearest: Well _-_______`¢_-___-___- ---__--Foundation ______________________ Prop. Line ____-___-.-..:..______L1� LEACHING LINE [4 No. of Lines ---------_---1_______ Length of each line________— '___-._____ Total Length _____� Q'_____________ 'D' Box 1---------- Type Filter Material -------2"--------Depth\'Filter Material -----------------1_9!±-------------------- ' Distance to nearest: Well ------- Foundation----- --:1U-.--___ Property Line .--_-_' _.__._.:-_.- SEEPAGE PIT ) ] Depth ---- 0_'_--------- Diameter ____4'X8' Number �'�_.___(F__-__t-_--_- Rock Filled Yes a No C] Water Table Depth -----------------901------------------------Ro& Sii e,- 2----------------------- f Distance to nearest: Well'"""'-------------------_ ---_--._Foundation --------- Prop, Line --------- �-'--. ........ REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------- ----------- Date ____'„_____--___---_____________-) ptic Tank (Specify Requirements) -------------------- -------------------- ---------------------------------•.--------------------------- Disposal Field (Specify Requirements) -------40 '-_Leach Line & Surp--- ! 8'X-1.4_'--------------------------------------- A + \ fes- `-/ (Dro,,V existing and required addition on reverse side) I hereby certify that I havepreparedthis 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 cigents signati),re 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-Compensation lavas of California.” Signed - -------------------- ----------------- Owner BY --- Title ------------Goritr-a.c-tar--------------------------------- (If other; than owner) FOR DEPARTMENT USE ONLY ` ,� ' APPLICATION ACCEPYED BY __ ___ _ -_- _ ___________________________ ------ DATE ------ -------------- --------- ---- BUILDING PERMIT ISSUED --- -------------- ----------------------------------------------------------------------------------------DATE ------------------------------------ `. ADDITIONAL COMMENTS ------------------------------------------------------------------------------------------------------ -----------=-------- -------- -_------------------------------------------- ---------------------------------------------- ----------------- ---- �E} `J - Final Inspection b --------.Date --------------- --------------------- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT ' E. H. 9 1-'68 Rev. 5M