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FOR OFFICE USE: APP11CATION FOR SANITATION PERMIT 7 5 - ........... ...........................:....� - �•-=. � Permit No. •.................... _ _4Cempleta.in Tripllcota).». _._.-.•.. __ _.. ...................................:.:.....' This Permit Expires t Year From Daae Issued Date Issued Application is hereby made to the San Joaquin local Health District for a per to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: `t JOB ADDRESS/LOCATION ....Z}2L��...G&rpexLte_r..' aad_•.....................:. .......................CENSUS TRACT .......................... Owner's Name ..-_..-krt Mariano .:....................•---•................................-.......:.....................:.. . a -..--------•----•-••------------ 1771 Lake . San N}a�eo �9�0� Address ................City r Contractor's Name ......;Rat_a__ao_0.ter... Barer...Se_r.'............_._....... - ......Liasnse�'z�1�.�9.......__. Phone J�(a.�_-2616.-____-- Installation will serve: Residencefj Apartment House❑ Commercial❑Troiler Court ❑ Motel ❑Otleer .......................................... Number of living units:_.._]------ Number of bedrooms .2.........Garbage Grinderysa_..._. Lot Size --aare---p111S................... Water Supply: Public System and name .... ... .............._.................__........................._....._.___...._.._........Private ]- Character of soil to a depth of 3 feat: Sand❑ Silt[3 Gay ❑ ' Peat❑ Sandy Loam(] Clay Loam ❑ ' Hardpan Q Adobe 0 Fill Materlal .no......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 pt permitted if public sewer Is available within 200 feet,) PACKAGE TREATMENT ( ] SEPTIC TANK I } -. Size......------._••................................ Liquid Depth..................... Capacity ;--_-----r--------PType..................... Material.--•................. No. Compartments " Distance.to nearest: Well ...Foundation ............... Prop. Line LEACHING LINE [ } No. of Lines ------------------------ Length of each line-------..........:.......... Total Length ........--_-_------------ I __ - _____.._.._--- I 'D' Box ------------- Type Filter Material ---_------_------Depth Filter Material --------- ........................... EDistance to nearest: Well ---- ------------------- Foundation .......................: Property Line ....._.._...___.. ...... SEEPAGE PIT [ } Depth ----_------------- Diameter ----------------- Number ............................�,Rock Filled Yes ❑ No - ` Water Table Depth .Rock Size ................................ Distance to nearest: Well Foundation -_ Prop. 'Llrie .........•............ F r f REPAIR ADDITION(Prev. Sanitation Permit# --------._.._----------------.................Date ................................... SepticTank,(Specify Requirements).---=----------•--..._.. .................................................................................................. a Disposal Field (Specify.Requirements install apps. 75' off' le.achi. iZ line and - -33 by 2�-- p1t-•-- -------------•- ----.-.---------- --- ------------ ------ ................ ................................. ........................---................ (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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Healtht Distdci. 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 Workman's Compensation laws of California." Signed ------ .---- A Owner -•------------------ --•-----•--••----••---... � w fBY a- /f�J�jP� - ... . Title -... 5:!e?. 1. I f of er than owner) _ FGR DI:PARTMENY USE ONLY APPLICATION ACCEPTED BY ------ --. --- - --- - •---------•---- -----------------DATE-.-.-..-_. BUILDING PERMIT ISSUED -------------------------•--..............:......_ -_.. ---------.......................DATE ......... ........-,....-.. ADDITIONAL COMMENTS ------------------•--...._.... ------------- ------•----•--- --. ....._......... .....................................-.. ---- /__7 Final Inspection by: ...- - - = Date ........ EH 1.3 2h1-b$ rev �l ...--- -.-----._._ ---- -- �-- -.. SAN JOAQUIN .L AL HEALTH DISTRICT 8/7h 3M F .