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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. � {Cornpleto in Triplicate) ...... .......... This Permit Expires 1 Year From Dot*Issued Date Issued ............. 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, JOB ADDRESS/LOCAT#ON,p.............l.. C .�. s:7-•..Cl�. kS..C.PI�r...........CENSUS TRACT .......................... Owner's Name .............1....f,J/1 /........... Phone --• ------ .............. ... . AddressCity A.W�reCY ..`Q�..._..... ---------------------- -----•--. ------ Contractor's Name -- - - " 1111_•�_!�_,.�.�/rl1.t.G..G._..-.License # .g ni _ Phone 4519�--1;2_960 Installation will serve: Residence 0 Apartment House 0 Commercial ❑Trailer Court Motel ❑Other------ .................. Number of living units:.AC,---- Number of bedrooms _ ......Garbage Grinder A91y. Lot Size ...............................•-•---....... Water Supply: Public System and name -------------- --- .............................. Private Character of soil to a depth of 3 feet: Sand Silt Clay ❑ Peat❑ Sandy Loam fl Clay Loam 0 Hardpan❑ Adobe ❑ Fill Material --•-------- 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 seepagepit,permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK f )Jr*t41*04 Size--/ _ ------------ Liquid Depth --- .......... Capacity --- Type - ---------------- Material-------•.............. No. Compartments Distance to nearest: Well --------------------- --------------Foundation --------••--••-------- Prop. Lina •---•-----------------d LEACHING LINE [ ] No. of lines -.---•-------- --------- Length of eachline._--:------•---.....-•__-•-- Total Length -------•---• -. ----------•elow D' Box Type Filter Material ....Depth Filter Material Distance to nearest: Well ........................ Foundation ------- ................ Property Line ........................ SEEPAGE PIT, [ j Depth -------------------- Diameter ---------------- Number ......................------ Rock .Filled Yes [3 No C100 ' . � Water Table Depth ----•....... -------------- ..........----------Rock Size -•-•----•-------- ........ Distance to nearest: Well ----------------------------------------Foundation __...._...__........ Prop. Line ....................... REPAIR/ADDITION(Prev. Sanitation Permit# ..._._._....----------- -------------------- Date ----------- ................... Septic Tank (Specify Requirementsl ......................................... •------• --------------- ............................. 7 Disposal Field (Specify Requirements) ...... _ - _ . ___._-- 57.-�_--- -- --------------------- -------------------...------------- ----------------------- ----------------------------------------------- ---------------------........------------------- .......................................................... (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 Health District. Home owner or'licen. sed agents signature certifies the fallowing: "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 Owner By --- C2..Y •-••------------------------ Xitle .._.. --------------------•- ------ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -............ .... ------------------------------------------ -•--------._. DATE ........... . •-------------------- BUILDING PERMIT ISSUED ---------------------------- /��-------- ••-----DATE ..------- -----------•-.....--------_..... ADDITIONAL COMMENTS .... •------ .-------••--- ------ -----------------------------•................... ....------------------- ------------------------------- ---------------- Final . -------••---••-------------- ---- ------ • - Final Inspection by; .. for Date _ EH 13 2h 1-6 8 �4 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M