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i c K OFHCE'USE: _ ` APPLICATION FOR SANITATION PEL,.of j� (Complete in Triplicate) Permit No. -----'---------------------------------------- __-..__ This Permit Expires 1 Year From Date 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/LOCATION -1��---- ---,t ----1-_ONE-__ ft-----FJ)--------------------------CENSUS TRACT ----- .---...------ Owner's Name -----P97F------LC.(.R.FirjL�r.4 -----------------------------.-----------------------------Phan/ -------__--------- - .. Address .._22g -S--r�r-----------wal'�----- R. '---------------•--- City - .�ttA A/--- -------------_-------- ....... Contractor's Name will serve:--- Residence ---Apa ---- ----------- ---------License # ------------------------_________- Phone _529'.570 .... Installation [ rtment House❑ Commercial ❑Trailer Court 0 Motel ❑Other ------- ----_---------------------...... Number of living units:-----I------ Number of bedrooms '3._____.Garbage Grinder _ Lot Size ACRE A_:C�_...._....__.____ Water Supply: Public System and name . - ------------------------------------------_---_----------------- -----------Private ®� Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan ❑ Adobe ❑ Fill Material .!-!.O_ 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 pit permitted if public sewer is.available within 200 feet,) PACKAGE TREATMENT [ I SEPTIC TANK{lJ� Size_S_X.I.O._.�S_._._s----------_ Liquid Depth .}./�........_ Capacity 1.50_0----.- TYpePR.FFPB__ Material__�01vC.F?---,No. Compartments .._�_....... L rr Distance To nearest: Well ----- .__^ -------.....Foundation ---IO..-1--__.. Prop. Line .S_______-------- LEACHINGrLINE [-J�No. of Lines .__.�-_.__._.._ Length of each line.-::__- 77 IS . . ----------- Total ___ 'D' BoxType Filter Material ROC—r.....Depth Filter Material ..---1�-.----.---.--.;____--- Distance to nearest: II ._..-.._- n _�Q.__. > Foundation Q_. .._7!-_-.__ Property Line _IT_...._'�'...-.- SEEPAGE PIT [ J Depth -------------------- Diameter _____ ---------- Number ------------._._----------- Rock Filled Yes ❑ No I] Water Table Depth --------------------------------------------Rock Size Distance to nearest: Well ---------------------------------------Foundation ------------------ Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ' ' ` Septic Tank-(Specify-Requirements) ................... - '- --------------------------------------------- ---------------- ------ Disposal Field (Specify Requirements) _ ____ --- -..._--- ----- - -------- - ---- -- -- ---------------------- - "--- ------- - - ------ --_-_------ (Draw -_ _ --- (Draw existing and required addition on reverse side) ^` I hereby certify that 1 have prepared this application and that the work will bye done in accordance with San Joaquin Y\ County Ordinances, State Laws, 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, 1 shall not employ any person in such manner as to becom su [ect t orkman's Compensation laws of California." Signed - - - ------------------------- Owner ,. By [If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------- --------- ---- -- - ------------ DATE BUILDING PERMIT ISSUED .__ - DATE .....___-------------_._ ADDITIONAL COMMENTS -- -- ----------- - --- ----------- ------------------- ------- ------------------------ - -- -- ----- ---------------------------------- ----------- -------------------------- - ------------------------------------------------------- ---- --------- ----- - - ---- ------- - - ------------------ - ` - ---- ---------- - -- -- ----- - ------------ ---- ----------- -------- - ___PW__ � _Z01-.... . ------ - Date - rF -----V ----Final Inspecti --- - ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT F H 9 1-'AR Ro„ FM