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05/04/2003 08: 01 469-811, JEFF RGGE?S 1. —-' SIG PAGE 01 + FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT LFOR OFFICE USE: (ComPloie in Triplicate) No.This Permit Expires 1 Year ham Data Issued ued.. 3� �� Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described This application is made in co plionce with County Ordinance No. 549 and existing Rules and Regulations: B ADDRES6SG/*T? �-T $rE SR4CT� .. Owner's Name.,V..r.!y+ ..... ./.r!C.!lie - __.............._.. - - --.__...................................Phons.._........g32UT....... Address..... .5...... .iZ ,,t'1 �.. . Cstallator's Name ve: . x- ... lr':.(r!!�. . ..C.�......Licenso #.'a.1.•.:1�.•.�� ..Phone..�.1F-.?^.^.-.Vew Instailotlon will serve: Residence[]I Apartment House d Commercial Q5 Trailer Court ❑ Mote! ❑ Other...----................. r t .. Number of living units:...... -- . Number of bedrooms... bage Grindr�-'Lm Sue. - :....................... Waver Supply; Public System and name...........................•., e .............................................................�......... . ......Private Character of soil to a depth of 3 feet, Sand❑ Silt El Cloy El Peat❑ Sandy Loam ❑ Clay;Loam ❑ .� Hordpon I] Adobe', Fill Material.._..._.....If yes.type................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) NEW INSTALLATION; (No septic tank or seepage pit permitted if public sewor is available within'200 feet) ` PACKAGE TREATMENT [ J SEPTIC TANK [ Z� Size...............-..........................................Liquid Depth........I............ Capacity... ., ype.......................Motorial _ ... . ..._ No. Compartments.... I 41 Distance to nearsit; Weil........, 0�......................Foundation....LQ....... .....P Urs. LEACHING LINE ( J No. of Lines........... roP• S•••�•---•--•-•---,•• .......--.--•..Length of each Ilne..,,,1� ,� . .........Toto) Long/h.IOQ„................... .... 'D' Box..../,V4.Type Fiber Motor lal---- ,.Depth Filter Material....._IS” Distance to neprest:Well........+ r r.,,,_,---- t. ........Foundatign.-------..!•__�J__....._.:_Pra r � Line............. . .. ---_-------, �r"- Property 7 SEEPAGE PIT [ I Depth..s�rS....Diameter... ........Nunnbor...... r rr Rock Filled Yes No❑ Water Table Depth................1.0.0....._.......... � r, \ _ .._.:..._. ..Rock Slze.........,��......"..2�?e.............. : Distance to nearest. Wall..........Ll,!S, ._� Foundation__.....�.SQ.:...._..Prop. Lino....__. ._'-...._. . REPAIR/ADDITION (Prov. Sanitation Permit#...._........_ .......Date................. Septic Tank (Specify Requirements(................... Disposal Field (Specify Requiraments)................. r•-----..........,....,--•--._.,.........._.....,................... .....................................`............................. ............................................. ......................................I.._-_..I. . s . ..................................,....._........................................._.........:.,........................................... (Draw existing and required addition an reverse side) 1 hereby certify that 1 have prepared this application and that the work will be dent in accordance with San Joaquin County Ordinances, Slate Laws, and Rules and Regulations of the Son Joaquin Local Hwlth District. Home owner or licensed agents signature terrifies the following: 4. —"' - --- "I certify that In the performance of the work for which this permit Is issued, 1 shall not employ any person In much manner as to become /�s{{u��b/sff��a Workman' Componsallon laws of California." Signed........ ....................Owner By.......... r.............................................................................. ..Title.. _........_..............................:........... (if other than owner) ' ne DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....... DATE ?.._....3 30/7.17 .. DIVISION OF LAND NUMBER........... r.. • ' •-d-<... _ _ _ p ADDITIONAL COMMENTS............. .,A...ui;_ ......d_.'.1.a.r!.._.....l� I (tL.. ..,�> d.. ...._........................ , [C..................................... .......... ............................... . . ... . ---------,.._..I--------------------- „ - Final Inspection y /r. �. , , . ..... _ _............... b :........ a./.r........:......r:......_........................_......._...............__.......__.._.._......—Dole.. .. .........f�............. EN 1324 SAN JOAQUIN LOCAL HEALTH DISTRICT Fa lien IAV.me IM