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R OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No,. _7�-�------------ -- 7 - - ----------- {Complete in Triplicate) -------- --------------- ------------------------------ ---- ---------- ----------- Date Issued � 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 ------of!a.--FQxes-t---Lake---Hd-V----off-_SacramPato---Rc1_CENSUS TRACT ------------ ----- ---- - • �r - -_-_ -----Phone -1'2Q9-3�i9-6268 Owner's Name _ e _o_-- rove Harold-Willi- -kms Address _.'_X05--41-G!,4 --atreet,---Galt-t---C-alif-_rnia---------------- City ----------G_alt-------------•------------------------------------------- Contractor's Name ---------- License # ---3 8178`------ Phone ---48377Q 7A.--•-- installation will serve: Residence JE] Apartment House ❑-Commercial ❑Trailer Court ;❑ ; IMotel ❑Other -------------------------------------------- Number of living units:____ _____ Number of bedrooms -_-_3-----Garbage Grinder ------------ Lot Size __1000_ ___ ___acres___ __----_____-______- Water Supply: Public System and name -------_= ----- ---- ----------------------------------------------------------------Private ] i Character of soil to a depth of 3 feet: ' Sand'❑ Silt❑ Clay .❑,, . Peat❑ Sandy Loam ❑ Clay Loam 0 r _ Hardpan E] Adobe F-1FillMaterial ------------ 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 [ ] Size----------_-1200--ZA11o__n------- Liquid Depth -------------------------- Capacity _.1500-.-galype No. Compartments 2----------------- Distance ------------ -Distance to 'nearest: Well ------------------------------------Foundation ---------------------- Prop. Line ` LEACHING LINE ( ] No. of Lines -2-----------------Length of ech Bne-----10QLF---------- Total Length _-2.09L'------------- 'D' Box __--1_----- Type Filter Material 3 3/A–,1/_2*_Depth filter Material --------------------4-----------•----------- Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line --------- ------------ s SEEPAGE PIT [ ] Depth ___25-1-___-_.__ Diameter ------3_6tl - Number .-.--.-----,2;---------- ---- Rock Filled Yes [A No i❑ Water Table- Depth --------------------------------------- --------Rock Size ---------c_obb-le--------- Distance to nearest: Well ----------------------------------------Foundation -------------------- Prop. Line ------------_------- REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------------------------"Date __-----------=--=-----------------} Septic-Tank (Specify Requirements) ---- ---------------------- --------------------------- ---.---- -----------•----------------------------- Disposal Field (Specify Requirements) - ____----_ ----_" ------------------------------- -------- ----- ----------- ---------------------------------------=---------------------------------------------------- ------"---- ------------- _ (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 . 4 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 I as to become subject to Workman's Compensation laws of California." Signed c Owner 14-_ -------- -- -- V�f anitaion� lc� By ------By Pre dt� i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ _ ____-_-- --- ---------------------- ------------------------------------------------- ----- DATE ---//-G� �------------- BUILDING PERMIT ISSUED ----------------------- ------------------ --- --DATE ------------------------------------------- ADDITIONAL COMMENTS ----- - --------------- elC-----j-`---=----- - ----------------------------------------- -------------- - - ------------ ---- -------- -----"----------------- --------------------------------------------------------------------------------------------------------- J - -- --- Final Inspection b - ' Date SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M