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FOR OFFICE USE: �., ... APPLICATION FOR SANITATION PERMIT C ..... . �:. )�Gfi a 11z .................. tComplet*in.TrlpHcahl . Permit No. ................. �•• �. ... ......... Thi=Permit Expires 1 Year� Dat*Issoed Date Issued h ............ Application is'hereby made to the San Joaquin Local Health District for a permit to construd and install the work hereln described. This application is made in cam Banc ith County Ordinance No. 519 and existing Rules and Regulations, JOS ADDRESS/LOCATIO D ®• �,Q/151,E L .-----.----...�......_!� --=--•--- .,A/.-_._L.........................................CIrM _ Owner's Name ............ C}..Y....._ ' .. S � • F Address -... ...._.__ Phone . � ... . r�1�.---• ......... ...... ........... ri..... amu; '� . Contractor's Name ..... a :. r - Lkense Phone- - - Phzzz6 j6©� Installation will serve: Residence[Apartment House fl Commercial oTraller Court Motel[❑Other_... :_._Gar ....:::........::..:.. Number of living units:_....._f._._ Number of bedrooms �J i .. ..._. bye � . �` ..-�- ---.... ...Z.��.:. Water Supply: Public System and"Warne ' ..:.... .......... ` -. ........:: �d :._ .� .._.... .........Pr•wd*0 Character of sail to a depth of 3 feet: Sand C3 Silt C3 Clay 0 Peat Q. Loam{� `-Clay Loam Hardpan[� Adobe ' Fill MaNrlal............if ye:,type....... (Plot pian, showing size of 'lot, location of system in relat€on to wells, buildings, eft, must be placed an reverse side.) NEW INSTALLATION: ; (No septic tank or seepage page pit.permitted If public sewer is available within 200 feet,! PACKAGE TREATMENT _ [ ] SEPTIC TANK{ Sine.: -:-•--•-•-•.•----- ....._.... Liquid Depth Capacity - ---..._ ...._ Type rr.- ...... MatBrlal...- -• r- - No. Compartments --•............... Distance. to nearest Well Foundation .... Pr . LEACHING LINE t 3 No. of Lines _:. c : .. ...... ............ . Prop. line.__..........._..... _ . .. _... Length of each fine................ .B ..... r ........... Total Length , ........................ ox .-----J-.. ype-Filter Material .............:.....:Depth Fitter Material .............. SEEPAGE Distance to nearest: Well .................---._-- Foundation Property ........................... PITD • ----._--_. Line ........................ ,�..�..�..� [ Depth •••---- . Diameter Number . ..... Rock Filled Yes No Water Table Depth Distance to nearest: Well ___________ ............ . ..Foundation .......... Prop. 'Line . REPAIR/ADDITION(Prev. Sanitation Permit# ............................... . "# Dafe ...........................} Septic Tank (Specify Requirements) ...... .:...... ; Disposal Field JSpeci Require encs) - - ..._.. . . -. .._ " � ... .................... -............. , 1 l ----• ....... r - ` - ---•. (Draw existing and r uired ddition on reverse side} I hereby certify that I have prepared. this application and that the work will be done In accordance with San Jeagv'ln' County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HOW&District. Hent* owner or. Iltow sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shalt not employ any person In such manner as to becon ublart 1_"orkman's Compensation laws of California:' Signed _. ._ By ....................... Jitie :.. cr:Ga-t�._._.. �_...-__.... Iif other than owner} OR'DEPARTMENT USE ONLY S APPLICATION ACCEPTED BY _.....•---------.._..._....-•- ----•- -- - -- ------ DATE, BUILDING PERMIT ISSUED . _ -- ADDiTi4NAiCOMMENT - --- - ----------•-----•......................................... ....... .-...----- ._......----DATE ... Y.. { -•-- ---------------------------------- f ----•-- Final Inspection by EN 13 22t 1-6€3 ................. .............Date .��i._fes= ..........:..... S JOAQ IN LOCAL HEALTH DISTRICT 8/731 3M