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FOR OFFICE USE: NPPLICATION FOR SANITATION PEV.jT ................................--------------------- 14wo PermitNo�.��.%zt��5 (Complete in Triplicate) .................................................... This Permit Expires 1 Year From Date Issued Date Issued .."�. 7 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: HAYED" ACRES RIVER CLUBS --------CENSUS TRACT .......................... JOB ADDRESS/LOCATION . - ------- .. -- I------ - - - ........ ..:..... - Owner's Name ..Harry BLACKWELL. and Audrey K''. LILEr. � _ phone982-9.479................ 1691 W, Frevyert Rd �(,f L - -00 Lathr©p Address ......................... 1t� ,�� 1/l.Ti� - Contractor's Name OWIt@I doing work. / .Lice se # ..... Phone ... ........................ Installation will serve: Residence❑ Apartment House-[] Commercial ❑Trailer Court (L4cc.�e r7p� %Ri.`/err) Motel ❑Other ............................................ Number of living units:-----6---- Number of bedroo4..at:...20arbage Grinder mOTM- Lot Size ........_..................._............. Water Supply: Public System and name ---------------Wgll"_0.n.-.pr©pet`ty----,"...-_........-...............................:.Private IN Character of soil to a depth of 3 feet: Sand j] Slit❑ Clay ❑ Peat ❑ Sandy Loam Xj Clay Loam❑ Hardpan ❑ Adobe E] Fill Material ...._. ----- If yes, type ------------------------_- (Plot ------------------------- -(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,) r PACKAGE TREATMENT [ ] SEPTIC TANK [ j Size....: rX..-J I_ ----_,--- Llquid Depth ....0.4n - ---- Capacityfad6��y.�ype ......-............. ateria ..O, CFOtt:. Na Compartments .-...2............ -•' Distance to nearest: Well ..._300.......................:Foundation ---------------------- Prop. Line 9.Yer....59... LEACHING LINE [ ] No. of iges ." ONE.... Length Length of each line....100--.-,---,---.-, Total Length ...:.1.w!............. D' Box x16 (yp8FilterMaterial .._.-Rock- -Depth Filter Material .......1$-................................ Distance to nearest: Well _300............ .. Foundation _..:a::_::. Property Line SEEPAGE PIT [ j Depth .................... Diameter ................ Number .........._------- ........ Rock Filled Yes ❑ No Water Table Depth ................... ....................Rock Size ... ------.... ...--......--- Distance to nearest: Well ........................................Foundation .-._. ........... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# .,,_....._...,, Date ..........................--.......I Septic Tank (Specify Requirements) ---------._'.`._':............................................. ...................... ................-.............--------- ............. Disposal Field (Specify Req'Viremeills) ........................ .. v`n ...................................... - - - - - %...-....... - ....................................... (Draw a sting 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 becomect to orkma ' Com ensation laws of California." Signed ...... . C " -- - Owner By .......................................................----....-................_....---------- Title -------........... .........__..---------- ._........_...--__.. (If other than owner) ARTMENT IJK^ LY APPLICATION ACCEPTED B .._ -=- .... ......... - r -... DATE `Z.. 7 ........................ BUILDING PERMIT ISSUED . . ....... .... - . ................._.. -_.-..... ... ••.. - ....-.........DATE ADDITIONALCOMMENTS ------------ ........................... ...................... ---_--_----- -- ---------- ---------.......------......-----------•-------------...----- .......... ...............------.....------- ....................................................... .......... ......----- -........._..............- ................... ...... ........ --•- .---- .... ...... -- ...... 1...... b - r ------------ -----------Date ...7. 7 Final Inspect!( - .... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M