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'+ FOR OFFICE USE: - - - . ... . .. ... .. . .. ... APPLICATION FOR SANITATION PERMIT ' (Complete In Triplicate) Permit No. ..... .. .. ... ........ ........................................... This Permit ExPlces 1 Year from Dnte Issued Dab Issued 11-1 !2.S - Application i hereby made to the San Joaquin notal Health tDistrict for o permit to construct and Install the work henM' described. This opplimtion Is mads In compliance with Cou ty Ordino/y , a. 519 and existing Rules and Regulations, •f. . JOB ADDRESS/Lo�+TIONlro7�Q7 .,,'CCt��....� ,f-.—O�.E. TEE . l-/�{,r �j�Jt .r Owner's Name -1.V�4JV. .. '�LfJ,,,,, .. CENSUS TRACT ........... .. ..... .. .. .... . ............. Phon.�7 0?? G .. Address 30.70 y .E.,.LeNc... . .ii e . .lg,1...... .._. cl . l' ry0A kdA/t . .. ... . . . .. .. .... .......... Contractor's Name.. L.F. 01-2.d It '.. ....... ......... ...... ...................... ..License t ...... . .. ... Phone ....... Installation will serve, Residence ffi Apartment House Commercial❑Trallw Court Q Motel❑Other............................................ w 1 Number of living vnits,.. .1..... Number of bedrooms ,. `. .....Garbage Grinder .. . ...... Lot Size C? a,w�C....V.GI.Cl.Nn0. , I Water Supply, Public System and name ......................:........._.... . ' ................_...................................................Privab$�' Character of loll to a depth of 3 feet, Sand Q Slit❑ Clay ❑ peat ❑ Sandy Loam ❑ Clay Loam C] tit n'. Hardpan Adobe❑ FII!Mutertel ............H s, .: ye MI»............... ....... E (Plot plan, showing size of lot, location of system in nilatlon to wells, buildings, etc. must be placed on reverse s;71 NEW INSTALLATION, INo septic tank or seepage pit permitted If public sewer is avoilable within 400 feet,! PACKAGE TREATMENT a [ J SEPTIC TANK[ 1 Size........................................ Liquid Depth .......................... 's Capacity .._................ Type ................... Material...................... No. Compartments ...................... Distance to nearest, Well ....................................Foundation...................... Prop. Line... ..................fa LEACHING LINE Qct No. of Lines . .... .... ... ..... Length of each line .................... ..... Total Length 'D' Box ...._ . ... Type Filter Material ....................Depth Filter Material .... ^} Distance to nearest, Well ........................ Foundation Property Line ` SEEPAGE PIT [ I Depth ....._............. Dlomoror ................ Number ............................ Rock Filled Yes ❑ No Q Water Table Depth ......_........................................Rock Size .......................... ..... 1 Distance to nearest, Well .......................................Foundation .................... Prop. Line ...................... N . REPAIR/ADDITIONIPrev. Sanitation Permlt# ..................L........J............... Date ..................................I ..jl &tptic Torek (Specify Requlremenh{ .... . . ............... . . .LS.. .......Q. .._. . .. ...f.,,, pp S� Disposal Field (Specify Requirements) M ..... 1 ........................ .........._. _........................................... . (Drove existing and required addition,on reverse side) I hereby certify that I have prepared this application and that the work will be done In accordance with San Jeegstle "i. County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hem*owner or lieets. sod agents signature certifies the following: "I cenlly at In the performance of cite rk for which this permlt is Issued, I shall not employ any person In such manner i. as to be subject t�yy{Ior 'TCo�m5tton )laws of California.,, Signed _kj.(�..... _..._. ...... Owner yJr By . .. .. .. ...._ ..... .. .... . . title . (If othe on owner) - -' - - FOR DEPARTMENT USE ONLY l Urrt'.I� Pe,r�Zg- 96B `^ Q,.....v_.._..u... APPLICATION ACCEPTED BY ,_. ._ DATE .... BUILDING PERMIT ISSUED .._ DATE ... ADDITIONAL COMMENTS .. _ .._ ...,. Final Inspection by: ✓// J/Q'„ .. ....... ...... Doteto EH 13 2b 1-611 Rum.51 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M