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S 4 A # FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT - ............................................. k Permit No.�17�:..�'`? 2 (Complete in Triplicate} .........................�. ....................... .......... - .- .•---• -----•------•-•-• This Permit Expires t 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .................CENSUS TRACT ........................ Owner's Name Diane Fa].aOne...•---••••... ................ - Phone $3,�-'�O.-----•........ 8 80 ..................West Fairoake Trac Ca. s .... Address Trac Contractor's Name .,,Pt,Y'"I�� "---S.e�t c._T•�k_.*...SejRer"38TVLicense # 261. ' _.... '4'�,�j�8 98.. n . r Phone --.... ....... .Installation will serve: Residence a Apartment House 0 Commercial f❑Trailer Court a Motel ❑Other ............................................. Number of living units:_..I...... Number of bedrooms ... .......Garbage Grinder...A0---. -Lot Size. ..-l0-acres Water Supply: Public System and name ............. ------------.._._._.......-----------••. ---.......---.._........-_•-•-----•- - .PrivateX Character of soil to a depth of 3 feet: Sand 0 -Silt❑'�,Ciay ❑ Peat❑ Sandy Loam,[] — Clay Loam. Hardpan ❑ Adobe ❑ Fill Material .......... if yes,type ---------...I......:......•. (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[ ] Siae: .:............................................ Liquid Depth .................... Capacity .................... Type .................... Material_...............-... No: Compartments ...................... Distance to nearest: Well ...................... ...........Foundation ......... _---_---- Prop. Line .................. ` LEACHING LINE X] No. of Lines ....I................. Length of each line..*. ................ Total Length --,, ( �_•__.. ...... 11 'D' Box, --- Type Filter Material .ASA........Depth Filter Material _-_19................ . .........:_.. Distance to nearest: Well _- �t.__P u Foundation 10� plus Property Line _ 151' .pl_.S-•.. X1.1 SEEPAGE PIT [ ] Depth ....��.._.. Diometer��:_ Number ........... ..........:..... Rock Filled Yes 8. No C3 Water Table Depth 35t-------•------ ..............Rock Size 1w21 11--.we:shed. rock Distance to nearest: Well ................Foundationl4l.__p AP. Prop. Line --- 1.__P;us_ REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date ..................................I Septic Tank {Specify Requirements) ... '.......-- �-•-•-•---- - _ ...... P , . � IDraw 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.Nome owner or licen- sed agents signature certifies the following: "I certify that in the performance'of ork for wh hthis i s permit is issued,'ll shall not employ any person in such manner as to beco lett to Workma Com ens o! California." Signed ter_ . ... .. Owner . f . _ Title ....Contractor... ...................................... :.......... er an ner)P erry ©„ Warthan i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1 ..5. .....................................................I-..__.-•---•------•-- DATE ..... i 2_• BUILDING PERMIT ISSUED .....DATE ............ ............ ADDITIONAL COMMENTS ............. ................... ... --••--•-•----•-----......_...._.......................---•-......--------••- ---....._ ............. ------•--- ---- -- ----:.....-.. --- ......... .. . ... ------- --._. -----------.._ .. --._ • ..................................... ..... z l ...,_....` __.._.. '--................... ----•---••-•-•--- .. .. .. ..... .... ... ... . . . ... ..._...._......__....._................ ......_._.. / ...._. Final Inspection y .........--•----....--••--•--------•-----.. ate ........................... .. -- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.13 241-'68 Rev. 5M 7/723 ,4