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rUK UrrK.t UJC: ` APPLICATION FOR SANITATIONIT PM {Complete In Tripiicate) Permit No.7...-.-9.0 This Permit Expires ] Year From Date Issued Date Issued.` �. Application is hereby mode to the San ,Joaquin local Health District fora permit to construct anelre' II the work herein: described. This application c ed. h s opp cation is made iirr compliance with County Ordinance No. 549 and existingpegulotions, n i JOB ADDRESS/LOCATION •t I ..CENSUS TRA � � �-- � �.��c.�...c,�. lac_.....- . V- ----- Owner's Name .. . ., 'FAI.... R X0L-1414................... ............... .....................•----.......Pho n. e ................................. Address &U,//.. ....�e r,114 � . 4"t7 . ...---.-:_.. . City ,�14 G� yw�. ........................................ Contractor's Name .. ' 6 G G�GC� ► :.................license # .� =U�./.. ..._ Phone Installation will serve: Residence ❑ Apartment ;House❑'Commercial [:]Troller Court ❑ Motel ❑Other Number, of living units: . Number of bedrooms .........Garbage Grinder lot Size .... Water Supply, Public System and namePrivate ❑ ............................. Character of soil to a depth of 3 feet: Sand VT Silt E] Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ `\ Hardpan ❑ Adobe ❑ Fill Material If yes, type .. (Piot Ian, showing size of�lot, location � p g tion of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: INo septic t I k or seepage pit permitted if public sewer is available within 200:feet,] PACKAGE TREATMENT ( ] SEPTIC TANK{ ] SiZ0, -------...••-............ ... .................. liquid Depth .......................... F Capacity Type ..._ Material....;... 1... ' ....... No. Comportments ...................... Dis ance to LEACHING LINE Not of Lines nearest: Well length p ..............Foundation . ... ........ .._ ._ Prop, Line ..................... ( ] f each line . ..... Total Length _.:.. ....................... D' Box Type Filter Material ------------------Depth Filter Material ........ _. ........._._..._............... Distance to nearest: Well _. .....- •.---..... ... Foundation ... ............... .. Property Line --...................... SEEPAGE PIT ( ] Depth . -__... Diameter ................ Number .......... Rock Filled Yes ❑ No ❑ . Water Table Depth ................•-•----------.r...................Rock Size ................................. Distance to nearest: Well ..................._..... ...............Foundation ............ . Prop. line .................... REPAIR/ADDITION trev. Sanitation Permit# ........ . . ..... _.....:. -.-._--- ... Date .................................. $ep 1 pfy } Requirements} I Qo.... r,�./��..........X!�.-'......' Disposal Field (Specify Requirements) .f.kl .....5 .'� � .............................� ...---- .._............_....:....... I ......... .........._ ....... ............. (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done in accordancst with San Joaquin County Ordinances, Stpte Laws, and[Rules and Regulations of'.'the, San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the plIrformance of the work for which this permit Is issued, I shall not employ any person in such manner as to beco * sub'ect FoWorkman's Com motion ws of California." Signed . . . ........ .. Owner By - �J �'CJ Title �fotl herkhan owner) R DEPARTMENT USE ONLY APPLICATION ACCEPTFD BY J.. . DATE . /G` T. ........... . . . BUILDING PERMIT ISSUED . DATE ADDITIONAL COMMENTS .... .. ....................... . ..:........ _ ............................... i :.. ...................:.. - ..... ...... .-----._............ S LL 1. Final Inspection by: ....L.... ....... .........................--. >.._.... Date ... r SAN JOAQUIN LOCAL, HEALTH DISTRICT