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FOR OFFICE USE: R A.SANITATION PERMIT AP 1C�,,ATa ION FO Permit No. (Complete in Triplicate) ; ------------------------ ----------- ---------------- Dat,. a Issue ____ This Permit Expires 1 Year From Date Issued d 3 --------------------- A-. Application is hereby made to the San Joaquin LoSI Health District for a permit to construct and install the work herein described. This application is made in com f liance',with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 1 u G Rd. aper®x 1m1_18..f�''QM-- CENSUS TRACT ------------ ------------- Norh Thornton rd. } " Owner's Name ----W.�,l3a---�''-ex-€t~tle --------------- --- ---- Phone r/94--2643 Address ------------ •�� -B ac--143--'------• `" -----. City =-T-hii nto-1----------------- ------------------=------- -- Contractor's Name .--..0 il- ers teY'h aC1l_t ti®Y1 FI1C. ------License # -18178-4--____. Phone _4-83--84,71------- Installation will serve: Residence ®.Apartment House,[] Com mercial ❑Trailer Court ',❑ Motel ❑ 4er, --- ,---------- ------Number of living,units,....-..._. Number of bed -- .2.;_..Garbage Grinder --------._-. Lot Size -------------------------------------------- Water Supply: blit System andlname --------- -- - -------- - Private [J ------------------------ ----------------------------------- Character of soil to a depth of 3 feet: Sand's Silt-E] "Clay ❑ Pe`at E] Sandy L6am ® Clay Loam;0 :�Hardp' ] Adobe '❑ Fill Material - : :. If yes, type ---------- ---------------- lot plan; show g;Lsize of lot, locationif system in relation to wells; buildings, etc. must be placed on reverse side.) W INSTALLATION: lNo septic tank ar seepage pit'permitted,if,public sewer is available within 200 feet,) AF PA E �]TREATMENT [ ] SEPTIC T•ANK' µ Size-12_ 1 ,•� OQ---�r&11-6-ri -------------- Liquid .Depth -------------------------- Capacity --- -----------------Capacity 2_200& L Type---------- Mdtbrial_.0__nC re to .No. Compartments -2-----------:---• E :. Distance to nest Well 2Qp�t ------ Fondafiion =- -1E�!---------- Prop. Linef------------- LEACHING LINE [ ] No. of Lines -._ €Length"o# eacFi line... fl�-- _-,------ Total Length .--I 5.0------------------ D' Box ------------ a Filfer Material X4_..__Depth Filter Material --3fif'_....................... ..---.- Distance to nearest: ell -...2:f� "f:_____... Foundation ----10-1 Property Line _..�.f.:.............. SEEPAGE PIT [ j Depth -------------------- Diameter ...__-_-_ _..._ Rock Filled Yes No C] ----- Number ------------------- ❑ Water'Table Depth --------------------- -------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------Foundation ------------------- Prop. Line -------------:........ t REPAIR/ADDITION(Prev. Sanitation Permit S# -------- ----------------------------------- Date --------------------- ------------ Septic Tank (Specify Requirements) ------------------- ----- -----------------------}--..----------:----------------_-------------- -•---- Disposal Field (Specify Requirements) ---------------------------•-•---------------------------------------- -------------------------------------------------------------- - --------------------------------------- ------------------ - ----- - ---------------------------------------------------------- ---------------------------------------- -- ---------------------------------------------------------------------------------------- ------------ (Draw existing and required addi' on revve�errse� side),.- Y �: I hereby certify that I have prepared this application and that the wo wilYbe done in accordan Mwith: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 Wo an"s Co�pensatian Idws of California." ...� Signed "�_ 17t- 't9ClsLTC�-------------------- ewrrer/Contra�csr BY _...__ Title Pref----------------- (If en---- - - --------------------------------------------- (If other owne F R DEPARTMENT ONLY APPLICATION ACCEPTED B r p - ,�t---- -- --------- -- ----------------- DATE ----- y BUILDINGPERMIT ISSUED ------------------------------------ -------------------------------------------------------------------- --DATE --------------------------------------•---- ADDITIONALCOMMENTS --------- -- ------------ ------------------------------------------------------------ -------------------------------------------•------------:-------------- ---------------- - --- -------------------------- ---------------------------------------------------------------------------------------------------------------------- -------- ---- ------- - ------------------- ----------------------------------------------------------- -W_ _ ------------ Final ----------------------------------------------- --------- Final Inspection by: --- ------------------------------------------------------------------ --Date r SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M