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FOR OFFICE USE: AP ` PLICATION FOR SANITATION PERMIT t,... :. �.. II to Permit No. ... 3_'?� 5` I � �I (Complete in Trip Triplicate) .......................................................... This Permit Expires 1 Year From Date Issued Date Issued ... ... Application is hereby mode,'to the San Joaquin Local Health District for o permit to construct and install the work herein described. This opplicotion.is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 108 ADDRESS/LOCATION ;L241 N. Filbert_ :........................CENSUS TRACT .............:------- -OwneOwner's r's Name ........B.enMLaugr.tte..............•-----•----..........•-----............... ............ 7.627 School Cit Stkn. Address _... = -- -•.. ............... y .-.. ... i , Contractor's Name ...lac ard! s 'Septic ' and "� .................License # ...�689��------ Phone ..�?b3"`70 •........_ Installation will serve: 'Residence[3Apartment House❑ Commercial ❑Trailer Court fl Motel ❑Other ............................. ._....-:.., -- Number of living units:.._..,,._._ Number,of bedrooms ...... ....Garbage Grinder .... Lot Size ._-_p�601xi.00 t--- t rWater Supply: Public System and name . c Y...._._....................:,* -.........._...............................Private ❑ Character of,soil to a depthT! f 3 feet: Sand b .Silt[3Clay E] Peat❑i-Sandy Loam {] Clay Loam ❑ Hardpan ❑ Adobe S] Fill Material .......I.. If yes,type ............................ (Plot pian, showing size of lotJocation of lystem 4mrelation 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'204 feet,). 11' �'X !X3.4' ... ._' Liquid Depth ................ 811 PACKAGE TREATMENT [ ]�� -SEPTIC TANK f j Size-----------------=----•------------------ q p ................ --------- '1200 . T e .�C--'-•-•--:----: Moterialooncret.. No. Compartments �...................... Capacity ------------------- YP .... � r • Distance' to nearest: Well -----�-�wr�:-��....------Foundation ..--...�. ....----.. Prop. Line :.._. .:.•........ I ... length of each line=--_---------------------- Total length.�'........:---=:.......... .LEACHING LINE [ ] Nod: of Lines ..............._._.. 'D'!'Box .........___ Type Filter Material ................... Depth Filter Material .---_. ..................._............ r _ I '.S x ...._.._-- Property Line Distance #o nearest:-Well ........�. *... . �Foundatian ' SEEPAGE PITS[_ Depth_---------------------- Diarr►eter � ' Number ---------------------------- Rock Filled Yes ❑_ N6J:3 �A WaterTable Depth ........ ItI, __ �.........-----. ....................Rock Size .........--•••-----.. ............ ..._.... ... _ ........... Pr p Line _Diance to nearest: Well ...:...I........ ..Foundation ........ ; i T rm• REPAIR/AbDITION(Prey:Sanitation Permit�# ..e:-•.,---•..s............................ Date ..__...4---------------------_-- Septic Tank (Specify Rei} irements) ....--- 120Q__,gr� - i .P. 1c..Tank...................•--••---•-- •--- , �.. --------------------....... Disposal, Field (Specify Requirements} w --- i......................... ..................... t ---------------------.:.:.......-------------------__._................................_............................- ------------------------------------ ....._...__...._..I...• --.................................................... .............. ........ .#c.._......._.._.. _... I� (Draw 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, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed .. III! Owner By .......... .R . cr- ; (If other than.owner) ` DEPARTMENT USE ONLY r i ,APPLICATION ACCEPTED 8 81hY ....... �.. .. .........�-- ----------••---••---------- ------- •.............. ....----------------. DATE.:'--;�__..r./.. .�._ . I BUILDING PERMIT ISSUED!'.......' . .... .........�.,1 ......................................................................DATE'...:-._..�.......---- ••----...... ADDITIONAL COMMENTS'!.... ..... ... .. .... c --• ....I 7 1 ...................... ---'----•-•--•..........................•-• .... ........................... __. n --------------------------------------- ---------- Final Inspection by: _. .... . .. ... -••--•••••-----••...........-•----••....._•..............................Date SAN OAQUIN LOCAL HEALTH DISTRICT 7/723M F_ N_ 13 24 1_, gV_ Mil: — —