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rUK UflftGE USE: 1 ` 't APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) Permit No. ----------- .__.v. p p tate) ...7...__...-•-••- F .................. This PermltEX ires 1 r Date Issued .__ P from bate Issued Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work j described.. This application is made in'compiionce with County Ordinance No. 549 and existing Rules and Regulotioherein JOB ADDRESS/LOCATION ISI J �.�)�T F .,-----•---•--------------A•1R- '..on! CJrxaAc� .�i6uS TRACT' AdeOwner's Name ................ �Nl?�.._ ................... .... ................ --------•-----......._.._...._......,. phone 178 3 ...................................... ......................_.... Address -••---•-- _....._..... ..._.. AIR R�r�---- ..........................city rn�^I`i«�1..... ........................ Contractor'sName C r Cr4 R C,,1� _.-•--- ...._.. 82,3 � CSg -----•-------•-------•..................................................License 3# ....._... ...�1.. .$... Phone ....-•--••----- Installation will serve: Residence LTHpartment House Commercial❑Traller Court. ❑ Motel ❑Other................•--........__. Number of living units:_.._ Number of bedrooms 2 Garbage Grinder nder N..n Lot Size i9'C 12eW� Water Supply.y: Public System and name .............. Character of soil to a depth of 3 feet: Sand Ug,'Silt❑- .. ----•............. ................................................... •-.._._..----.....PrivateCiay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 Hardpan 0 Adobe❑ Fill Material ............ if yes,type (Plot pian, 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 pit ,permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK ] Size...._1 ;;LOP.... 6.A� ---.....---•.........--- Liquid Depth . . .... .............. Capacity ? o .... Type . ..Tecrl wc s�' -- �. Material..__C� ------••- Na. Compartments .......�:.._. istance to nearest: Well -----/-�?�?................ ....Foundation __...�¢..... Prop. line .__ C)0. LEACHING LINE [ ] No. of lines ---•___-- --•---- Length of each line__..----`]... Total Length 6� 'D' Box t�rrs---. Type Filter Material .-- ..Depth .Filter Material ........�q.11. . . ................... Distance to nearest: Well Pv'!� ...... Foundation -__-_� �_... 00- .._..... Property line ....�...............` SEEPAGE PJT diameter ---------------- Number __...._ ._._ ...... Rock Filled Yes ❑ No �❑ �_ { ) Depth --------------- -- Water Table Depth -----•------------- ....Rock Size I Distance to nearest: Well ...... .................................Foundation .................... Prop. Line .................... REPAIR/ADDITION(Prev. Sanitation permit# ........... ............ -•----•-•-- Date --- Septic Tank (Specify Requirements) ......... __•---......................................................--- isposal Field (Specify Requirements) ------_------___ (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 Lbws, 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, l shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed --------• -- - Owner - -- .__--- ..-..------ --• ....... (i other than nor)--------------------------------------------- Title ............................................. DEPART NT USE ONLY - APPLICATION ACCEPTED BY ----- BUILDING PERMIT ISSUED --. ---•---- ----------- ........ ............... DATE ..--- ADDITIONAL COMMENTS ..... -•----------- ------• _ ------•-------•----------...-------- ---------•--•-----• --------------------------DATE ---- ----------._...__._....__. .......... --------•------ --- ------.------------. ....................... ------------------------------------------- _. _...__.._. --- - - ------- - ---..-... ... ------------ Final Ins eCtion b � - -- -------------•�--•---------••-------.....__..._.. -------------- ---•-----• ------- --------------•-•--•-----•---- ---------------------------- .-:.. ... _ f -...:.... EH 13 2h 1-66 zev. 5M SAN JOAQ N LOCAL HEALTH DISTRICT - $/71, 3M