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I� MW err+c:e Usf APPLICATION FOR SANITATION PERMIT —_ ....................."""-......................I._._.... Fermit No. ... y (Complete In Triplicate) .................................ry... r This Permit Expires t Year From Data Issued Date issued ...................L Application Is hereby`inadevto ttaa San"Joaquin Local Health~District for a permit to constnict and install the work herein � described. This application Is made in compliance with County Ordinance No. 549 and existing Rules es z and Regulatlonse JOB ADDRESS/LOCATION .........::�:.:__ 3_445...CoroTkq_ :4... ......... ............CENSUS TRACT .......................... Owner's Name .,/!l.1-I ..... puet.0 .............................................` ................... ...... ..-.. ......... .:... ... .Phone '3445 E;oronac#or Address ar ..................••--•---...._........-----.......:..: City ......St"e-btQn..................................................... Contractor's Name ......:........K�. a:KaQC '_ �5t r.. er............................License# 2715,39_.......... Phone465-2616 - 1I installation will serve: Residence®Apartment House❑ Commercial❑Trallw Court ❑ Motel ❑Other............................................ Number of living units:........ .. Number of bedrooms ..........Garbage Grinder?'.ell...... Lot Size .............................60 by 120 hl Water Supply: Public ----._....Ca1kF...W.terser..-•-•----._....................................... ...... •- --....."V System enc! name . .Private ❑ a Character of soil to a depth of 3 feet: Sandy ❑ Peat❑ Sandy Silt Clay Sa } ❑ ❑ loam ❑ day loam ❑ Hardpan ❑ 1Adobe tq Fill Materlal .' ...... If yes.type............... ............ (Plotla - - -- - - - - -- - p n, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT ] SEPTIC TANK f ] Size................................................ Liquid Depth ......................... Capacity .................... Type .................... Material...................... No. Compartments ................... Distance to nearest: Well .Foundation .......... Prop. line BEACHING LINE C ) No. of Lines ........................ Length of each line............................. Total Length .........................., 'D' Box ............ Type Filter Material .....................Depth Filter Material ........................................... I— " Distance-to°nearest:-Weil:.....:.....:.:::....._Foundation_.................................... Property line ...................... SEEPAGE PIT11 Depth .......:............ Diameter ........... .... Number ---•---•.................... Rock Filled Yes C3 No Water Table Defith ................................................Rock Size .................................. Distance to nearest: Well ........................................Foundation ................... Prop. line ...................... rev. Sanitation Permit# ...... REEsAIR/ADDITION'I)P ............... .....'............_. Date .............. ............... .) P septicTank (Speti#y Requirements) ......................................... ..............................»......... ..... ............._._.._. ................ ' .... ' �I Disnosal Field (Specify Requirements) k .......add..lr!�.$.`.'_..dxa,�.. Y..'�5.---seel3a��..P1t............... � ......................... ••-•------------- ••----....---- ........-----•--......_...........................----..................----..........---------.........................-•-- ....................................... -------------•........................-............................................................................................ - (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the worts will be dons In accordance with San Joaquin County Ordinances, 8 9 State laws, and Rules and Regulations of the Son Joaquin local Health District. Home owner or liven- sed agents sI nature certifies the-following: : n `°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." i .fined .... ............................. Owner Contractor By .. ................. .. ---.. _..--............_----................ Title .............................................. 11 er than owner). # FOR DEPARTMENT USE ONLY II APPLICATION ACCEPTED BY � .......... ... ...� -- ...-............-----.........-_........, DATE .-C/�... --------�� ,. BUILDING PERMIT 155UED ...........F.....:...............................................--•- -- ..... DATE------------------------------------ . ADDITIONAL COMMENTS ................. . I �f1.�...�":. r ..-----.9 t.. ................................... .....................................�I :: t :..... ...... ................. ........................... ................---..........-............---------. Fina.....sp —a ....-........ .: �.. } k ... ....:....................... Final inspection by: .... .....DateEH ............ .. f.. . 13 2a 1"6 °v• 5nSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M