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". APPLICATION POR PERMIT SANITATION T– . -..< . ............. ...........I................ (Complete In Tripttcatel Permit Nio. .75.:......5'. This Permit Expires I Year From Date Issued Date Issued -�-� w 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. 5:19 and existing Rules and Regulatlonse .JOB ADDRESSAOCATI N ....I_..��.. +�V VDN S4S7—r/� CENSUS TRACT, �+� �_. . ••----•-•--••-•...................... .. Owner's Name ........ ._�Q......._.._��F3 Iv�L �. ................................. ....Phone Address .......... � ..---u.Q.� �©S-T�1� -.._....••................ ...................... 1 .......... - ....CI Contractor's Name ...................License # ' Phone tnstallation will serve: Residence wXpartment House{]Commercial❑Trailer Court ❑ Motel ❑Other._ Number of living units:.... Number of bedrooms .3__-Garbage Grinder/y Lot Size �Q��e - ..... Water Supply: Public System and name CU R — S r.. ..... ....... ... .. �:�- _ ...__ � ..�......... ...........Prlvate ❑ Charocter of soil too depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat / Sandy Loam [] Clay Loam -Hardpan a Adobe(] Fill Material _A[l!.Q... If yet,type............... 'Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATIONc (No septic tank or seepage pit permitted if public sewer is avail ble within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK j Size....................... Liquid Depth .........-•-- ---- .........................� Capacity .................... T .................... Material...................... 'No. Compartments .....................� Distance-to nearest, !t-.�......�.:.......................Foundation ... ._.,,.......-.... Prop. tine !EACHING LINE [ ] —No. of lines ........._•..... ....... Length of each line....................... .... Tota! length 'D' Box ............ Type F(tar Material ... Depth Filter aterial .. . .. .. : ... Distance to nearest, W 11 Foundation . Property tine SEEPAGE PIT $ } Depth D me, y ` .................... .� .......'Number ................... . Rock Filled Yes ❑ No ❑0 - SEEPAGE � ......... ...... Mater Table Depth --. �, . ...........................................Rock Size _ ......._.._........_...... Distance•to neatest: l'^__.:..._- - - ...Foundation Lino................. ...:..._:....:..-�Prop. ................... REPAIR/ADDITION Prov. Sonitatian`Permit ' ( # . ................................. Date ............ .......- - --- } Septic Tank (Specify Requirements) ...................................... .. ..!...... ........................... I..!--....._......:. �. . . ........ ..... ...., Disposal Field (Specs Requirements) �� hr q 9 •-----...fix....... .)�r..........�AW(/4 -/Ne— u✓�.A�. .) ..... ._. `a'1, 'J-j�1I.G—....._ .Ef ! .�. , ,1. . � . { fl.C✓:.f�G7 vim.. _•---•---•-...--•---••-- -- --------- . .............................. =- - -_ (Draw existing and required addition on re"rse side) I hereby iertlfy that-I ha'v`e prepared this'applicistton dnd 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 licerw sed agent gnoture certifies the following.. "I certify a In the pe a of th w k for which this permit Is issued, I shalt,not ennplay any person In such manner as to be subject nsation laws of Callfornla." 5igned i.. .. .., _._... ` _ . Owner . ............... ................. BY -• ....................I......................... - e • . _ _ _ (if other than owner) ' R: FOIL,DEPARTMENT USE'ONLY, APPLICATION ACCEPTED BY ...... BUILDING PERMIT ISSUED ...................................... DATE ... . '.. ..n. - - ADDITIONAL COMMENTS ...... ... .. . :..... ...... _.._..----....... _..._.-•---•----DATE--.................._._. ........._....,.... ..... ..... . ........ ................... r.... - . .. .-- .. ---: ...... :------ .-- Final Inspectio .... . ........... _ L 13 21t • ......_.....Date . ......../........ ....------ SA V__ -S4W_1 UIN LO HEALTH DISTRICT g�7h 3M