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FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT --------------------------=--------- Permit No. 2-A r� ------------------�- [Complete in Triplicate} ------ --I ------ 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 -----2.84-5Q--- TO1!th---Thorrit n__RP64----------------------------------CENSUS TRACT -------------- ----------- Owner's Name tan l-ansen 794-2507 =---- ---- Phone Address --------------------28450 North Thornton Read. Ga-1t, California 95632: - - - - --- - - ------------- --- - - --- - ---------------------------.---------------- •ty k Contractor's Name ___C ].-: 1e a8 'S! __S:aX13 t t n-- I1c. __,________License# __ 178-- phone _483-8471 --------------- Installation will.serve: Residence$2:Apartment House❑ Commercial :❑Trailer'Court ',❑ Motel ❑Other --------------------------- # Number of living units:,.--6--_ Number of. bedrooms ___3-------Garbage Grinder ------------ Lot Size _____I _.[c e______________________ Wafter Supply: Public System and name -------------------------------------------------------------- -------- ----------------------------------Private [ Character of soil to a depth of 3 feet:, Sand Silt -Clay Peat Sand LOOM.V Clay,Loam .0 p Hardpan❑� ❑ Y ❑ ❑ Y � Y' ❑ p ❑ Adobe Fill'Material ------------ If,yes,type --------------------------- - 119 (Pl'ot plan, showing size of lot, location of system in relation to wells, buildings, etc. must'be placed on reverse side.{ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 260 feet,) D PACKAGE TREATMENT [ ] SEPTIC TANK'] . Size____-12 3Q__g3&ll0ng--_-------------- Liquid Depth __________________________ i Capacity -_12:00__$a�ype -------------------- Materiul__C_0MGr_Qt0 No. CompartrAents ------2`_....... :..-• Distance to nearest: Well -------100 s-------------------Foundation -----10t---------- Prop. Line ----5__t.....:.,_...__ LEACHING LINE [ ] No. of Lines _Qr10---------------- Length of each line_=.__x.00- ------------- Total Length ,_,].001........ ......__ 'D' Box ------------ Type Filter Material __14X3/4__Depth Filter Material _____________ Distance to nearest: Well ________________________ Foundation ------------------------ Property Line ______:_.-.__._.-.._---- x0eumm [ ] Depth -10-1------------ Diameter 2_1Wk10!bumber --I----------------------- Rock Filled Yes a No Water Table Depth ------------------------------------------------Rock Size ___Cobble -- Distance to nearest: Well ---10-0!---------------------------Foundation ____10_t--------- Prop. Line ----5_+_.______-____- REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------------------------- Date _-__--___-___--_--_ -------------- Septic Tank (Specify Requirements) ____:__-.________�_ } 4 ------------------------------------------------•------.------------------.----..--------------------------- I Disposal Field (Specify Requirements) -------------- --------------------------------------------------------------------- ------------- -------------------------------------------------------------------------------------------------_-------------------------- ----------------------------------------------------1----- ---------------- - (Draw existing and required addition on reverse side) iI 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 Son 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 W 's C pensati.on laws of California." Signed _ ' _ - _-- _-: :_ Q_ 10'D ------------- ®rswer/Contractor BY ---- — - -- -- ------ Title _J�'T'�S�S�e�7�----- ---------------------- [[f t r th n o er) F R E�F 4A111MENT USE LY OE APPLICATION ACCEPTED BY T �' G - DATE ____-- -X3'-__7.�-------------- - s BUILDING PERMIT. ISSUED ----- ---------------------------------------------------- DATE -- --------------------- ADDITIONAL COMMENTS ------ --------------------------------------------------------------------------------------------------------------------- --------------------------- -------------------------------------------------------------- ------ -- -- - ----- -------------------------------------- ------ ------ ---------- ----=------------- ------------------------------------------------------------------------------------------------------------------------- - - -- -- ---------------=------ --- ----------------------------------------------------------=--------------- -_- - ---- -- Final Inspection by: 5- :�. ---------------------------------------------------------------Date ----------/--------Z } SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.