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I FOR OFFICE USE: FOR OFFICE USE: �. APPLICATION FOR SANITATION PERMIT '✓ (Complete in Triplicofel PCrmit No.. . .... . -._............. ...... ..... ........ .. Dote Issued .. .._ . . This Permit Expires 1 Year From Dare Issued Application is hereby made to the San Joaquin Lnml Health District lot is permit to conshucl and insloll the work herein describaf. This application is made in compliance with County Ordinance No. 549 and existin Ruln and Regulations; JOB ADDRES,S/LO,Z'�4TION e. "/�j�/°�' r" ��.'�'"d'. . .. � CENSUS TRACT Owners Name �CtC//_T/LGAJc•.�r./tc./ �' �i..J Phone �G .� 7./x`0 Ad4`.dress. C% . .?Z .`— �l�,�lZ4i •.F'i'J~ City ;i�,•., Zip.-... .. Contractor's Nome.. ..O �:...�. j' . �-'•4+- 9 C, .... . . .. License # P,, Phone�i.��. . •' �� Installation will serve: Residence 6wj"' Apartment House J Commercial U Trailer Court (] / Moicl n Other .". ...... .. ... ........... ... / Number of living units: ,...Number of bedrooms .GGge Grinder ..Lot SizC. ... 'f" .,. ..,../.....................0 Water Supply: Public System and name. ... ...... ..._..... _...._.:.._... - . ...___....... _...._.. __. ...PrivateA Chornctor of soil to a depth of 3 feet, fiord Cj Silt E] Clay I_j Penr[t Sandy Loam Clay Loom Ll Mardpon Adobe ❑ Fill Motorial . ...... If yes.type..... ............-.... ... ------------------- IPlot pion, showing size of lot, location of system in relation to wells• buildings,etc, must be placed on reverse side.) N NEW INSTALLATION: (No septic lank or seepoge pit petmined if public sewer is ovoilable wilhin 200 feet,( PACKAGE TREATMENT I ) SEPTIC TANK (c-r /') ��Slze...`�X.v X _. .__.... ......_. .Liquid Depth . ... .. .... _lrf/ u.. Copocil ...Ty :• .Moterwl f-•L�' , No. Compartments . .. °�`....-_. Prop. rUismnce to nvaresh Wcll �DO_- ._ . . __ Foundanon../C� _.....LEACHING LINE (>-r No. of Lines...GV................... .Length of each l no ?.`CL.. �-1.. Total Length . I '�/ .. b� .0.... ..........Pr r Line. -;!. ..r . ...D' Box "" T Filter Material�' ''= tialDistancetoneoe�: Well DQ .✓ ✓ 'ound tion litter Mate ofk ry � �SEEPAGE PIT I'•T Depth .0>.r. DlometerN . . �7 , Rock Filled Ye� Wow Tnble Depth �O O.�.... .. _.. _.. .Rock Sae 4;1 Disionre to nearest: Well .S .Q...............I.....Foundation., ............. p, ..•�............. Pro LinC.. ..... ....., REPAIR/ADDITION(Prev. Sanitation Permit*, ...........................................Dwe........................... ................ .) Septic Tank (Specify Requirements) . .. _ _._._ ...... ... Disposal Field (Specify Requirements)...................... .......................................... ..... .. .. ... ... ... .. ...................................I........ _....._................ ....................................... . ......................................................... . ... ...................................................................... . . ... ........ ............... ... ................................................... . .... .,.. .. .. IDraw,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, Homo owner or licensed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 sholl not employ any person in such manner as to 6ecemo eytHleg to Wefkman's Aomponsation laws of California." .> 5gned.....t, ........Ownut .... �......... ....... ........ ::... .. j f.. BY ... ... . .. .. .l...._ P. ... ..... ..._........Title , .. pf other than owner) __ ___ .'_. . r.. FOR DEPARTMENT USE ONLY :.-...—:".. __ _ rnrw .......:.:......._....... —tLip�`F`:�sVC�Z:^ :G`.2�t!::•1��'.::..�:: _.�_�._�....._._.....�..._ APPLICATION ACCEPTED B . ..� ......................... .............I.......................,.....DATE .G2 ."-2-f:.]'7. DIVISION OF LAND NUMBER ....................................................... . ... ... . ..... . .. . ................. DATE....................... .... ADDITIONAL. COMMENTS. . . ................. ...................................... ... . .. . ..... .. .... .. .. ....................................... ............. .......................I.............-.............. . ...................................... .. . ... ...., ._.._._ . .. . ........ . ........................................................................_..........................I.. .......... .. . ...._......_......._.._. Final Inspection by:. ............ .. .✓ en a 24 SAN JL�A(�UIN LOCAL HEALTH DISTRICT rias 2107 rev. rife:e