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OFFICE USE. APPLICATIONsANRATIONI pw&w FO )MDQ.............................. » ... Kees/INe b TryiFalM ►erwnls Na . ...:.f.. This hnetnM E>�•e Peer lbw Dow bmw Date beued Application is hereby t•nokb to the Sass Joaquin Loud IMall)s Ol1lMtld fa o pessnN to conNruit and tngoll the work herNn described. This application Is nw le In complianp wink Ceunly Ondhwnce No. 519 and existing Rules and Regulations; JOB AODRESULOCATION ��-,� .... .SQ....s ..l�..l. /^... ' .............. . ..... IJS TRACT Owner's Name . I .'.. .%'flK,f}//. S.f. ,l........._..._................ ........... . . ........-Phone - Address ..... ... .... ............. . ........... Cby Contractor•s Name ... ,.moi .... � '. .! �i� :.Lken+�e• ,� .7. �'Phane .,///II,, 22A Installation will serve. Residence IXAporb mht lios►soQ Cosswhwrckd Ofrallw Court ❑ A40111111 13 Other Number of living units.--.`...... Number of bedrooms _-/—Gaboge Grinder 1-�q.... Lot Sire ......�...1�� ... ..._. Water Supply. Public System and none ................... ........_..............................._..........................................Prtvate(3' Charodw of soil to a depth of 3 feet. Sand 14 60 Q Cloy Q hot❑ Sandy Loan O Clay Loam❑ hardpan❑ Adobe O FII AAoterbl............if yes,............................ (Plot pion, showing size of lot, location of system In nelolbn to wells, buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit peas-'-- if public sewer is available within 200 feet,) PACKAGE TREATMENT ( I SEPTIC TANK t ) Slmr...._.._...................................... Liquid Depth ...................—:1Z Capacity.................... Type ......--- AAGIWW...................... No. Compartments ............... Distance to nearest, Well ....................................Foundation............... ...... Prop.Line............... _.. LEACHING LINE ( J 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 ( J Depth . .. .............. Diorneter ................ Number ............ ............... Rock Filled Yes ❑ No Q Water Table Depth .............:..................................Rock Size ................................ Dijtonce to nearest:Well ...............Foundation .... REPAWADDITION(Prev. Sanitation Permit f ............................. .............. Date ..................................) SepticTank (Spe.-ify Requirements) ................................._.................................................................... .... ....._ ...... -------- Disposal Field (Specify Requirements) ............ ... ........... ... . (Draw existing and 4equired additio., on revere side) I hereby certify that I have prepared this applicalion and that ct,* u-r.i. wii be done In accordance with San Joaquin County Ordinancds, State laws, and Rules and Rkgu' dons of the Son Joaquin Local Hec::th District. Ham* owner or licen- s*d agents signature certifies the following: "I certify that In the performance of the work for which this permit is Issued, 1 shall not employ any person In such mannm as to become subject to Workman's Compensation laws of California." Signed Owner r By /�!� ' Jitle (If otncr than ownerr F9R DEPARTMENT USE ONLY _ APPLICf,TI014 ACCEKED BYDATE BUILDING FEFIAJ ISSUED %�i DATE ADDITIOtJAL COMMENTS ,- f,nal in;prct.or, by �� ,iii , .,,• , 1:?1 1, 214 1-1,%ti 10CAL l;EJ',tTH DISTRICT ft,