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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` 1�v r ----- t• Permit No: (Complete in Triplicate) _______________________ .--__-----______________ ----- This Permit Expires 1 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 .------- 599___E.,_.Fopp_iana_____-- CENSUS TRACT --•-----------••----____-- ----------.:---------------------- ------- Owner's Name Hari'Y__MC.1,eL,,qL 0------------------------------- ----------------------- -------------- -------Phone --931n.310 -&-------------- t Address -------�Same----------------------------------- ------------------------------------ --------•--• City --S-tk--�----------------------------------•----------------••-•------ Contractor's Name _-__Blackard's Septic Tank License # -_ 6 9_51_--__ Phone _-_ 3 _7 8___.-- -------------------- 3 ,. Installation will serve:' Residence ®Apartment House[] Commercial ❑Trailer Court ;❑ I ° Motel ❑Other ---- -----------------------------------•--- Number of living units:--I------- Number of bedrooms ____I-----Garbage Grinder ------------ Lot Size ....5_ACI'e5---------------------- Water Supply: Public System and, name - Private Character of soil to a depth of 3 feet:' Sand'❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ R Hardpan ❑ Adobe K] Fill Material ------------ If yes, type --_-_-----_-___------------- t tW; (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,) I PACKAGE TREATMENT [ ] SEPTIC TANK ] Size_____ X5-'-xl0----_----------------- Liquid Depth ._._48 ND Capacity _- 0-------- Type --- sC-'-------- Material_99Z Crete No. Compartments ----_________ Distance to nearest: Well _120-01 ___3Ot-----______ Prop. Line --------- fl-0!.... LEACHING LINE fK] No. of Lines ...I------------------- Length of each line._IQ.p-!----------------- Total Length ,___-1-00-.1.............. 'D' Box ----1------- Type Filter Material tI___________.Depth Filter Material ------------19_.......................... _ Distance to`nearest, Well ----200-'----------_ Foundation -.,10-0-'------------ Property Line 1.00L!.............. SEEPAGE PIT �] Depth _______ ____________ Diarheter`_______36___ Number ____-___-_---- _____________ Rock Filled Yes Na Water Table Depth 9fl L-..................Rock Size ----------2-F1----------------- Distance to nearest: Well -- -20D t_____________________Foundation ___________1 fl�) Prop. Line ......_401...... l REPAIR/ADDITION(Prev. Sanitation Permit x# _______ ----------------- ___________________ Date __________-_______________________) Septic Tank (Specify Requirements) ----- -------x 20-0--gal. hep_tic---Tank------- ---------- ------ Disposal Field (Specify Requirements) ------10_0_'___I;ea.ch---L1nP__ __&____ 3"-X2-_ ______________ --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - A tk-----------------'--------------------------------------- -----------.-----------------------------------------------------------------------------------------------------•-----•- ------------------------------- -- --------------- - --------------------- --------------------------------------------- ------------------------------------------------------------------------ (Draw existing and required addition on reverse side) I 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 t as to become subject to Workman's Compensation laws-of California." Signed ----------- -------------- ------ Owner BY --- --- Title (If other than owner) FOR DEPARTMENT USE ONLY 22� APPLICATION ACCEPTED 8Y . - = =:L: ---------------- DATE -------------------------- BUILDING•PERMIT ISSUED --------------------------- _DATE -------------•-----------.----------------. ADDITIONALCOMMENTS ------------------------------------•----------------------------------'--------------------------------- ---------------------•--------------- ------------------------------ --- - ----------- ------ --------------- --------------------------------------------------------------------- ------------ ---------------------- --------------------------------- - ---- ----------- --- ----- --- - - - - -- - ------------- Final Inspection by. f = = Date �_.. .. ¢ ` SAN JOAQUIN LOC�'AL HEALTH DISTRICT E. H. 9 1-'68 Rev, 5M �- -