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j �• , 1i4 FOR OFFICE USE: APPLICATION FOR SANITATION PER?��C��-"` _ - - Permit o- --------------------- A --------- ------- -- : , --------- ----------- �-,_;-- �------ -- (Complete�-^- (Complete in Triplicate) -- ------------------- Date Issue ------------ pp ---- -- -- - This Permit Expires 1 Year From Date Issue it to construct l the work- Application ;s hereby made to tade in compliance ecwial tch Counealth UtytOrdinance Norict for a m549 and existing nRulestalnd Regulations:eih described. This application is m p I JOB ADDRESS/LOCATION _��D ------�- --� -- -� ------ -----�-)-P-�N..CENSUS TRACT ---------------- - I -- Li - 6S� j 1 P �C3 ------------------------------------ Phone -1- ' j! Owner's Name --- --- ----- -----. city Addresscense # � Phone - --- ------ - eContractor's NaI { - Installation will serve: Residence ❑Apartment House[] Commercial Trailer Court Motel [ Other "-1Q14`!tN_- QFF[-C _: XPAN5IQN Number of living units-r-4 Number of bedrooms---------Garbage Grind er .-__-- Lot size "."------- Private 11 1 --- ----------------------•--- ----- -------Private Publics stem and name ---_---__------------------ - Water Supply: Y 11 Clay Loam Silt Clay ❑ Peat❑ Sandy Loam El Character ofrsoil to a depth of 3 feet: Sand'[] ❑ + E] Fill Material -!V 7-=- if yes,type ------------ z �Hardpan ❑ Adobe (PI'ot plan, -showing size of lot, location of system in relation to wel{s, buildings, etc. must be placed on reverse side.) ted if public sewer is available NEW INSTALLATION: (No septic tank or seepage pit permitwithin 200 feet,) Size----- - ` PACKAGE TREATMENT I ] SEPTIC TANK..X -----'X- &---------- Liquid Depth '�,r a 0a �C . - --- Compartments -A ------•---- Capacity - �Materiai---cNo.Typ rs s DQ ---Foundation �� Prop. Line/, -- -------- Distance to nearest: Well -___- E ""-- Total Length LEACHING LINE No, of Lines --__-s"�-______.--_" Length of each line-------°-,ADO"-- "��-----•----,------ �-- 'D' Box __ _ _---- Type Filter Material 1�-- bk --Depth Filter Material � --- ------- ------------------- IIP-- ------------- Property Line Distance -to nearest: Well ---�Z�---------- Foundation I Rock Filled Yes ❑ No ❑� SEEPAGE PIT [ ] Depth Diameter ---------------- Number ------- -------- 1. r r~ :. Rock Size -------------------------------- . Water Table Depth ---------------------------- Distance to nearest: Well ----- _-_------ Foundation Prop. Line 1 = — Date ----------------•----------------- REPAIR/ADDITION(Prey. Sanitation Permit# -- - -----_ i Septic Tank (Specify Requirements) ---- ----=------------=---------=------=------------------------------ = r N1------------Disposal Field iSpecify Requirements) _- X�� 1- -�� ^f"� �NtP " { , S r = � ..= t"n� 13 4 ] QN -, 1 14CK FI_.rr Q-----`W`_--`--- --------------------------------- sr ----- - ----- ---- ---------------- --------------=-------------------------------------- ---------------------- ---------------- --------- - 4f (Draw existing and required addition on reverse side) ne in uin I hereby certify that 'I have prepared this application Regulationsthat the work will be of the San Joaquin LocaloHealth District.nce Hometh Son owner or leen- County Ordinances, State Laws, and Rules a r sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner F as to become subject to Workman's Compen3atlon laws of California." € Signed -- --- -�I�pA ------ 91�' °ty------------------ ------------- Owner _ --------------------------------------------- Title --------- ------------------------------------------------------------ By - ------------- --------------------- 8y ---" " " " "" (if of er t an ow ' FOR DEPARTMENT USE ONLY --�- DATE ------ 24`7 ------ APPLICATION ACCEPTED BY "" "-_1-- ` -- -------- -�---- -- --------------- --------------DATE ---- --------------- ------ ------ ----- BUILDING PERMIT ISSUED -------------------- - ----- --- ADDITIONAL COMMENTS ------------------ --------------------------- ------- ------------------------------------------------------- ---------------------- ------------------ ------ ------ --------- -_ ---- --'----- ------- ------.Date ----------------------- ----- ---- ______ ____ ------ -- Final Inspection b - ----------- ""--""""- SAN JOAQUIN LOCAL HEALTH DISVU-C ' r- u 0 1_'AS Rev. 5M