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FOR OFFICE ME f�f APPLICATION FOR SANITATION PERMIT 7 ...-. Permit No,2 - (Campiateln Triplicate).... ..... ..................................... Date Issued ..... ...... ............................................ p�p� This Pe it E picas t Y*ar From Dat*Issued KId Application Is hereby made to t1�e San? quln a ea th District for a permit to conNnitt and install the work herein described. This cep 11 11 1 made I c�a��iian with County Or anc Nw.s 49 existing Rules and Regulations: JOB ADDRESS/L&AON ....... / 0.... ._ ..... . CENSt)S TRACT .......................... Owner's Name ...0 .". -/ ...... .e //vc.X L.✓.. ±t vS •. .............. ....... . Phone,..� ..................:.......... ... Address . ...........-.... t�. , 7....L.,. M,.1 f l-✓...............•........_...•City .. ----........... .......... ... Contractor's Name ) a. ..License # Phone ._ :........ installation will serves Residence artmeM House(3 Commercial❑Trailer Court 0 Motel ❑Other- Number of living units:........I I. Number of bedroo s _J- ..-Garbage Gri.der C-44 Lot Size �Q�-.�,��•--....... ?._ Water Supply: Public System and name -0 --- ...................................Privah❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ pay Loam ❑ ❑ Et Hardpan Adobe Fill Material �Q_-If yes,type............... ............ p Mlot pian, showing size of lot, location of system In relation to wells, buildings, eta must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted i ybiic sewer is V lable within 200 feet,) PACKAGE TREATMENT ( } SEPTIC TIANK� ' Si e._ _ Liquid Depth ��Z •---•- Ca achy . ................ .. Maferiai. ..--_-... o.—ompartments .... Capacity TYpo� Distance to nearest: Well ... Foundation ...r .:-____-- Prop. line ),...---- 4-EACHING LINE No. of Lines ..{ ..., ..--- Length of ch Iine._.�r �............... Total Length ./ �,1..rJ. Z.::::::::: 'D' Sox Type Type Filter Material ......C ......Depth Filter Material ..... �::... .. . Distance to ne Well ....!. -/a....... Foundation .. .`�..1.......... Property Line ..,��...�........... SE AGE IT Dept Diameter .__.....:. _. Number ....... ........... : ... Rock filled Yea „ No .� Water able DepZ .............sem_ •-. ...... ..._.._._Rock Size ....l..�1..,L4.. .�! / Distance 4o nearest: Well .......,/J, Z� ...............Foundation . .,l - .----. Prop. Lins.. ....-.......... REPAIR/ADDITION(Prev. Sanitation Permit# .............................._Z;- ........ Date ....................-............. ) SepticTank (Specify Requirements) ......................................... •____.................................................. ......... ................. Disoosal Field (Specify Requirements) •-•............................•----•-......-- ......................................._-..:......---.....---...........-----........ --- -- .... . .... .................._...---- ....•................... - .................. ........__............ (Draw existing and required addition on reverse side) I hereby cortify that I have prepared this application and that this work will be done lit accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the'Son`loaquin Local Ni0llh-1DN Cl--Metn"'wner Of IIcen- sod agents signature certifies the following: "I 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." $gned -- ------- Ote . ... ._----•-.... _--•--_..... Owner yC 'y j.. .�oQ` ~Y- .................. Title ........G-,- .�.- r.�......r..,....__..... (1 than owner► ' FOR DEPARTMENT USE ONLY ...DATE ...�:y "� ....: APPLICATION ACCEPTED BY . ..-...- . . .........:........................................................... ..�. ... BUILDING PERMIT ISSUED ...........................DATE--.... ...., •.......................... ADDITIONAL MM T .............--•--•---- - .......... .......... �"'L: . .` ?�. .. ..... ..... . "-��............. . ..... .. - ................................................. .............................. .............. . final Inspection by. .....---. t - - .. y'"•'`...................................... ...............................Date ....... .. ./. .. ..!�.................... EH 13 2h 1.-•611 Hay. 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M