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,n• FOR OFFICE USE: + APPLICATION FOR SANITATION VERMIT G.51 Permit No.7 .... .... - -- -- - (Complete in Triplicate) a ......... Date Issued .� / .--7 f 7This Permit Expires 1 Year From DaIssued i, existing JlationsT Anprma'ion is hereby made to the San Joaquin Local Health Dy, Or for n permit to construct and install , ere n described. This application is made in compliance with County Ordinance No. 549 and CES TR CT rf fl .,�.-�-CENSUS TRACT •• -'-- '� JOB`ADDRESS/LCrCATION-3W. .. .l.- � ... o ��/ �Y Owner's Name . . .. '. . * -' ""•�. `�', , / - �i City b �,s Address ,�•irsy/.. �"/� ... ... ..__ .� M •• ../�I Phone � � ��,�:�a�ieas.l........_.i.:.;.....License#E Imo' Contractor's Names 1 Instolio'ion wi'I :.erve: Re_idenceX partment House❑commercial ❑Trailer Court a Motel ❑Other ........... .......... .. - - Y Si Numl:•ur of livin_i unitr. ..r......- Number of bedrooms . Garbage ander of.Size" v -'•' L � � ..... ., - Private te� • Chorr Supply: Public System and name .... ..................... - Peat Sand Loom Clay loom❑ . � VV ate Y ❑ pcter of soil to a depth of 3 feet: Sund❑ Silt❑ Clay ❑ ❑ Hardpan❑ Adobe .' FII!Moteria! ..........If yes Type (Plot Plan, showing size of tot, location c system in relation to® b• 9s etc. m�rst be placed art revorse side.) J ,. NN INSTALLATION: (No septic tank or seepage pit permitted if public sourer is available Liquidithin?Depth ) --- •----- . ,> PAC�.A•GE� TREATMENT [ J SEPTIC TANK[ j Size.......... , -.,: Capacity :. .. .......... . Type .... ..... ..... Material ...._. .. No. ortments - come --" '. Y ' Distance to nearest: Well Foundation............ ..... Prop• Line Length of each-line.. Total Length r --- LEA LINE,i [ ] No. of Lines .............. .. 9 'D• Box ...... ... Type Filter Material ..................Depth Filter Material .... Pro ..Line . ._.. .......... . Distance to nearest:.WPI ... ................_. Foundation _--.- _ Patty . Diameter .- Number_ ..:..:. - -RockFllled--Yas-L7 No {j SEEPAGE PIT [�) Depth .--- ..... ...---..-... k Size Water Table .Depth ......... .................. ...............Roc <• Foundation Prof Line •-' t l Distance to nearest: Well . Date 1 ...... ....... • REPAIRJADDITIONIPrev. Sanitation Permit sit......... . ..__... :• „yi - , . Septic Tank (Specify Requirements) .. .. . •- .'.'. ... ... Di sol Field-(Specify Requirements) ;.. r _�/' lf'1 � ��.X•w7-.fie :: ... ... ..._ ... .. ....._ ' .......(Draw existing and required addition on reverse side) ,- 1 ! herobY certify that I have prepared this application and tl:nt the work will be dens in atenrilanm with San :sagv:n '., County Ordinances, State Laws, end Rules and Regula of the San Joaquin Local "with District.Home owner or Ncwn• sed dgente-signoturs certifies the following: -- - -- ' '9 cert that in-ehe performance of the work for which this permit is issysd,I shall.net employ,cny person In such manner �. rc as toib"Geto subject to Workman's Compensation laws of California." a .._Ow e: Segni _ .. .__ BY. d!^!i=«>scram'*c•^ ......................................... ... itis...LG!i�r¢. . _... ... edit other than owner) =- - 1 FOR DEPARTMENT ' U AF ACCEPTED B n'777-T ..... •. ...............-...•.•••..•• / USE O . ............ ' dUILDiNGPERMIT. ISSUED .. - ........�1i3.� --• �tD-A"b" _ Te ADDITIONAL COMMENLS. --.. .c/.(c�• -••- - � �/ .e►.. .. i . ..s6r L....(�Sj�✓.. ...v/d...Qte.q/J�.ewF ......... .....:..... ...4✓V..e.... - _........... Date. .r'' / /.- .... . Fnai)n ion by:......... .- . ' SAN JCSOUIN LOCA! HEALTH DISTRICT E.H.9 1=68 Rev.5M