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Pr O VICE USE: <br />P ° APPLICATION FOR SANITATION PERMIT <br />Complete in Triplicate)Permit No: ---7_ <br />This Permit Expires 1 Year From Date Issued Date Issued __3_ _- <br />Application is hereby made to the San Joaquin Local Health Districtrfor a&permit to construct and install the work hereindescribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br />2 F82 Car-oenter-•Ad,—JOB 'ADDRESS/LOCATION --------- ------------------- --- 1 CENSUS TRACT -- <br />Name .---------TOMMY Williams___--Phone . -62—.2, 2.3-9--------- <br />Address City -/S tkn-;--------------------- <br />Contractor's Name $ d-' Septi-C---TR k-----------------=-------License4 ---268951----- Phone ---46-3'-7 4 ----- <br />Installation will serve Residence Apartment House Commercial Trailer Court ', <br />j I Motel Other <br />Number of living units..-;y7__1 Number of bedrooms -----5-----Garbage Grinder Lot Size ---------------1__.C ____________. <br />Water Supply: Public System and F= Private <br />Character of soil to a depth of 3 feet: Sande Silt " Clay Peat Sandy Loam Clay Loam 0 <br />f Hardpan ` Adobe %] Fill Material _____________ If yes, type ---.--------------_- <br />Plot plan, showing size of Iot, location of system in relation to wells, buildings, etc.' must be placed on reverse side.) <br />NEW INSTALLATION: (No septic tank or seepageI-pit-permitted'1f-public sewer is available within 200 feet,) <br />PACKAGE TREATMENT .[ ,] SEPTIC TANK.{ 1, Size-_!-____ Liquid Depth .____________-7---------- <br />Capacity --------------------- Type -------------- r __ <br />No.. Compartments <br />Distance to nearest: Well -------------- Foundation ---------------------- Prop. Line ---------------------- <br />LEACHING <br />l <br />LEACHING LINE [x] No. of Lines 1------------------- Length of each line--- 9Q_'--------------'Total Length -----90_',___________..._. f' <br />D' Box __.__.____-- Type Filter Material __2'!---------Depth Filter Material -----------IQ'! <br />Distance-to_nearest-WeII.__.___-________ _______BQ f- Foundation. _ '--------- Property Line ---8_;_-. --•........ <br />SEEPAGE PIT i Depth -------------------- Diameter ---------------- Number Rock Filled Yes- • No iC /a <br />t Rock SizeWaterTableDepth ----------------------- <br />Foundation ? <br />rDistancetonearest: Well ------------ Prop. Line ------- ----- <br />REPAIR/ADDITION(Prev. Sanitation Permit # ------------------'°. t------------------ --- Date --------AU.F•---- 2 <br />Septic Tank fSpecify Requirements) - <br />0 Leaeh_Lne.Disposal Field (specify Requirements) __._9____-_- <br />s <br />Draw existing and required addition on reverse side) <br />I hereby certify thatI have prepared this appiicatio'ri and`thaf tl e" fork will be done in accordance with Sari Joaquin <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br />sed agents signature certifies the following: <br />I 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br />as to become subject,to Workman's Compensation laws of California." <br />Signe d 5 <br />Owner <br />By Gi c! Title --------Cantractor <br />t If other than-owner) ; <br />r FOR DEPARTMENT SE ONLY <br />APPLICATION ACCEPTED BY"_--_______-__.___- ---_--DATE all <br />BUILRING.,PERMIT.ISSUED -------------- -- .........DATEADDITIONALCOMMENTS --- -- -------------- ----------------- - - - <br />Final Inspection by: Date <br />SAN JOAQUIN L6CAL HEALTH DISTRICT <br />E. H. 9 1-'68 Rev. 5M <br />d.