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It/ FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 p f 1�! Permit No. (Complete in Triplicate) p Doi- Issued _., This Permit Expires t Year From DaN Issued Application is hereby mode to the Son Jooqvin Local Health District for a permit to construct and install the work herein described. This application .s modv in comphonce with County Ordinonce No. 349 and existing Rules and Regulations, YIA rr�a� tt,��a*res 2 4 ?._`y �, "f •-/�'� f- 'w5 t�wcr Owner s Name ��.•M•y "J`C-�` lrPhone city ld ' Zi Address Z�iJJ it c} ^/� �.-7 �i,e, . R. Ci c� .�. p Contractor's Nome CQJ . ��%. + .l.�' '>�. . t. .. License # 32 > !:• Phone _ Installation will serve: Residence❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ')Iii -u..0 14-- e`-- Number of living units: Number of bedrooms -2 Garbage Grinder Lot Size Water Supply: "rvbl;e System and name Private (� Character of soil to a depth rf 3 feet./ Sand .1Silt❑ Clay El Peat C3 Sandy Loam [:] Clay Loam ❑ Hardpan LK Adobe❑ Fiil Material If yes,type ---tj (Plot plan, showing size of lot, location of systerr, in relation to wells, buildings,etc. must be placed on reverse side.) — NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) r PACKAGE TREATMENT ( j SEPTIC TANK (� Size S .... X. �.O �. .x..-s.- r Liquid Depth Capacity 1100 O Type PA_"4 4 Material Compartments i / Distance to nearest: Well 5.0._......... .. . Foundation Prop. Line - LEACHING LINE No. of Lines 13 Length of each line q O 1 Total Length f 7- 0 / - D' Box I Type Filter Mat1eriall G t, Depth Filter Material J 4_1.1 Distance to nearest: Well e .w..Foundation I 'O Property Line S SEEPAGE PIT (VT/ Depth 1- S� Diameter ti Number. .. 3 Rock Filled Yes No❑ Water Table Depth /.'>7..f............. ..... .... _ . . Rock Size � /� r. .3 Distance to nearest: Well Foundation / Prop. Line REPAIR/ADDITION (Prev. Sanitation Permit#E Date ) Septic Tank (Specify Requirements) Disposal Field (Specify Requirements) ...•. (Drow 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 Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." qq SignedOwner L By J�>ItftG ){ l `�6�1i'L(y Title Cl'�cL�IRC-r�4 (If other than owner) Q FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY / ' C7''Z-� DATE DIVISION OF LAND NUMBER / DATE ACDITIO,NAL COMMENTS �/ ' Final Inspection by !�-�� .//Je• 4�lX"L-�,{ Date ,� i :) :4 SAN JOAQUIN LOCAL HEALTH DISTRICT Fas en 111 7,76 7M