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FOR W: APPLICATION FOR SANITATION PERMIT .............. ... . ... ......... .......... ( lite In Triplkatel Permit NO. . S.:.......y. _........ .......................... �Ci P-Or'1 bC" This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work heroin described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulatlonst JOB ADDRESS/LOCATION ..3jJ!�PQ S X 5;6-9fN1 ]--> ......CENSUS TRACE `S Owner's Name .. .....�'!.R:5. . .0.........��..F?.F ..4f:�. ..Phone .................................... Address ... . --..�/. nn ........ .....Y�..-��--..f�l91.1��Q!�i1...City ............................................................................ Contractor's Name ANTW �.. ..... ........License# ........................ Phone .............................. Installation will serve, Residence�partnuntt House Commercial QTrallor Court ❑ M01101 . . . Number of living units:....i. ... Number of msbedroo .! .....Garbage Grinder . Lot Sise ............... lel c��f9 V!N' I�! C'LV Water Supply, Pubik.System and name .s�t .. _ ........1.01U ..............R..._. .....-----...... .?.....................Prhrate Q Character of soil to a depth of 3 feet, Sand❑ Sib❑ Clay ❑ Peat 0. Sandy Loom 0 day Loam 0'' Hardpan Q Adobe Q Fill Material /.�[.o...If yes,type........................... !Plot plan, showing size of lot, location of system M relation to wells, buildings, etc. must be plated on reverse side.) NEW INSTALLATION: No septic tank or see pit permitted if public rower is available within 200 feet,) r 11 PACKAGE TREATMENT ( ] SEPTIC TANK size.....jl...X�o. . ................ Liquid Depth ...3V............. Capacity . �.�...5.9....... Typo PAKFnZ Material C JN . Compartments .. ....... 4istance to nearest: Well ..... :w:.............Foundation Prop. Line .. ..: .... TEACHING LINE WI'No. of Lines ..-1................ Length Of each line..rZ..z......,XJY..f Total Length .....30Aq.. .. F/ LAR B F-F-o 'D' Box/..;;- - Type Filter Material Depth Fitter Material JI .f.............. Distance to nearest, Well ...Cee. ...... Foundation ....,lQ..:-:4-. Property Une ..:"�'........ SEEPAGE PIT ( ) Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No WaterTable Depth ................................................ ock Size ................................ Distance to nearest: Well ..................................... Foundation .................... Prop. Lite ......................TIP- Distance (Prov. Sanitation Permit# ............................................ Date )- SepticTank (Specify Requirements) ......................................... ..............................»............................_...............................�. Disoosal Field (Specify Requirements) ...........................--........................................................................................................ N ............................................................•----••-•----.............................._................................................................................---......... (Draw existing and required addition on reverse*Idle) I hereby certify that 1 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 Dlstdct.Home owner or licen- sed agents signature certifies the following: "I certify th3h in the pe ecom the work for which this permit Is Issued, I shall not employ any person In such manner as to bec a subject oensation laws of California." Signe _..cam. ...-- .. ....c.................................... Owner By ..... ............. ... ..................................... .. :.�v.............. .Title .... .. ................................................................ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -7-1-•' . �.............................................. ............................ DATE . :.� -.7.s...........:: BUILDINGPERMIT ISSUED ............................................................................---..........................DATE.. .....................--•-----...... ADDITIONALCOMMENTS ....... .... ... .........._... .................................................................................... 10 .........- . .... ... .. ......... ..-•... ............... .. ..................7...-----............ .......-- ... .. .. FinalInspe ._ ...................Date .. .. .............................. EH 13 21t 1"60 Rev. 5qt SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3H