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FUR OFFICE USE: �I RI APCATION FOR SANITATION PERMIT FOR OFFICE USE: ICompleto In Triplicatel I Permit No. .. ...-... . ... .. ' This Permit Expires i Year From Date Issued Dote Issued6r,.* APpl-cotion is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein described. %s application is mode in compliance with County Ordinance No. 549 and existing�Rules and Regulations, JOB ADDRESS/LOCATICNJ. .vZpli .5..LC!..,q,t/s�t...- 4Js4..d....G.Lt........CENSUS TRACT.................. ........... Owner's Nome , ..JC7.�7rwh... . .�0..... ... ...... .. ... . ... ............ .. one?.Qf . -.. . .�.W61 p . Address.�.Z.T s.. .1C7/'(�C... .... cf!/p�lb.. ..{.%/!�•. . Zi e `` �,/ n..... ... _/ .. ... Cry. .. p._�.�..5...1�2..Q... Conhac:oi s Name 4:51' s �..�.f�Ay_.,...(,.�!�ff�j'Y!L//dh.... ..License #.SiT..IrAV3 Phone-SVe.0.79 ?a. Installation will serve: Residence ❑ Apartment Hove C,om rc101❑. Troller Court ❑ , Motel ❑ Other. BC. /Jfdb/LC A Number of living units: ..............Number of bedrooms........ Garbage Grinder............Lot Size....yQ../7C. 1 1 Water Supply, Public System and name . .......................Private Character of sail to a depth of 3 feet: Sand Silt to Clay❑ Peat❑ Sondy loam❑ Cloy loam❑ Hordpon ❑ Adobe❑ FillMaterial . .. . . If yes,type...................... . [Plot plan, showing size of lot, location of system In relation to wells, buildings,etc. must be placed on reverse side.) �J NEW INSTALLATION: Mo septic tank or seeeppoge pit permitted if public sewer Is available within 400 feet,) PACKAGE TREATMENT I ) SEPTIC TANK PI (n�_ //SS�ize IDlST�2.. _.-. .........I... Liquid Depth...C��6...-_... ...� Copocity.�OROV,a..j(Type/7.L40, . Material GLNGj'C�G.No. Comportment,......02.. ........... ...� Istonta to noaresit, Wolf...AQ..... .. . _...... .........Foundation .1s.Z ... . .Prop. line LEACHING LINE No. of Lines 'J........ . Longith 4 each line_..!yY ........ . Total Length D' Box / . type Flitsatoro / lf,-2 �I. Depth Filter Material. IF...... .. .......... . ._.. ... ........ / Distance to merest)WeIV hv.`. . . ... . Foundation.......ly_...... ... Property Line......"`. .. . ....... SEEPAGE PIT [Lr Depthd2S. Diameter.. ..'s Number ... ............. ..... Of it Rock Filled Yes 14No Water Table Depth........le�.......,.-�. .t .. ... .................Rock Sfu. _I.� Jl �... .Z ............. . Distance to nearest, Well ....../�7� . _._..... ......Foundation 'yQ. prop- Line� �T...... REPAIR/ADDITION Trey.Sanitation Permit#................ ... .. __. . .......Dat, ............ _ .. ) Septic Tank)Specify Regviremenisl ..�..e................ � . . .. .. 0istoasal Field tSpotIfy Requirements) /�/eA1'�.•..d 4 ez jr/4 _ Z. ,atj co"API 9 W- ...... ....... ... ...... .......... _..... ....... ..._..... ... ........... I...... . ... ................... .... ... . . - ........ .. ....rl........... . [Draw existing and required addition on reverse side) 1 hereby eeMfy that I he" prepared this application and that the week will M deme N accordance wfeh San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin total Health District. Home owner or licensed agents signature certifies the fetiewing: N certify Ihw In the performance all IM work for which this Permit Is Issued, 1 shall net empley any Pers" In such manner as to become . t to Work en's Compensation laws of California." Signed . Owner BY Title G �-=... ......... ..... - _ _. pt other than ownerl _ FOR DJPPARTMENT USE ONLY APPLICATION ACCEPTED BY .-ti/ DATE 6 1 DIVISION OF LAND NUMBER DATE ADDITIONAL COMMENTS .... ... _. . .. Fmol Insoecr,on by: Dare 7— 5 7 9 DIV- e1A^„_r1A�L�.S-% 1 A UIN LOCAL HEA/LTH DISTRICT /�_ )lS n U) SIV ):)r IM