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f 11 1$fTT� �Np•c. FOR OFFICE USE: r 11_7W _ APPLICATION FOR SANITATION PERMIT yz (Complete in Triplicate) Permit No. ..7...... ... ..........,.......................... ................... .. ..................................................... This Permit Expired Year From Date Issued Date Issued /.1Y9...'.. .� p' .r`. Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and e ' ting Rules o d Regulations: t' JOB ADDRESS/LOCATION .:i�I.LC.cI.... Gt.....J�,sat+.'.. ....f^ ..->(eG' s,[%.S!/::.:.....�CEN US T� ... f Owner's Nacre / f� ..- -..f.............. -... .......fU,dL/�.L..lr�.....�Nl......................... . .. ................................Phone ..�I.-9'.S.�.�.:..... %,..: Address ..._ ...._ :2.^9! ....jLr-..._C:IQ.J�..�tJl1......16�L✓D.....r...City ......W,4/J.✓.//--c&#........0U.I.Zf......... so. TT f Contractor's Name.......IV4ZT.1�'W-a........`Ori..S.Jf..................License# B.J" `,.?&hone ...... F ' u � Installation will serve: Residence C]Apartment House Commercial ❑Trailer Court fl Motel❑Other......�i.(1,(! ....1. ....._!/�`f✓T.t:E- Pb a e-6" Number of living units:............ Number of bedrooms ............Garbage Grinder ............ Lot Size ....../:3 �... .Ci.......... Yf Water Supply: Public System and name ................................ .................._.... .................................. ....Privat5, , Character of soil to a depth of 3 feet: Sand[] Silt I Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam \ Hardpan❑ Adobe Fill Material............ If yes,type............................ S (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 sewer is available within 200 feet),: PACKAGE TREATMENT f - K f ] SEPTIC TANK( ] Size.........JA.eoE Liquid Depth ...... .�...... .. ' y Capacity ................ g ...(GaO...... Type . .tt.cr..C•s'.�Material....t.?..<..�,.... No. Compartments ....6 Distance to nearest: Well ..f4n.......................FoundationProp. Line ......t� r LEACHING LINE No. of Lines . Len \ [ ] ......rA7.............. Length of each lina._..:A..v..._........... Total Length ...d:a�................ p � - 'D' BoxP.,,C...... Type Filter Material Filter Material .......................4....... OOO Distance to nearest: Well .�.V..:.✓....�. .. Foundation Property Line ...L??.r.............. SEEPAGE PIT ( J Depth a5............ Diameter .Al-........... Number .......5.................. Rock Filled Yes ® No ❑ Water Table Depth ...........44.............................Rock Size ....... ....... .o.lPro Line ...l.. . ` ✓ .............Foundation :G.k Sv...� p. LA.L_ Distance to nearest: Well ......�.fP.!___/.� .._......._._ REPAIR/ADDITION(Prey. Sanitation Permit#........................................... Date -------...........................1 Nr!i - ... Septic Tank (Specify Requirements) . ......... .:^1....................... .._..........................................-_--.._................. - Disposal field (Specify Requirements( - �� ............. ..- ..'.......... a........- ................. rs.. c5si.. ... ..... _ ._. . _ . .. ._. .._ .._ .._ ....... ................ .. ..... _ ........ ._... ..... ... ......... ... ... . ....... a tDraw 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, Slate Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- `. sed agents signature cwTifies the following: , "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner � ? as to become subject to Workman's Compensation laws of California:' ' (a Signed LUA[J -.!?ft_ /� /` 9 _.. - ... .l CrlS.T...S..O.......... ...... Owner . .........._ ...._._....... AF9 By .. .. I .... _.��'".'T �.✓...7��f':>y ... .. Title .. .us--.�.1. . +�. Ili other than owner) ✓/ _ DEPARTMENT USE ONLY at i APPLICATION ACCEPTED BY..... fs . .. ...... ___.. ..... DATE ...� hft BUILDING PERMIT ISSUED . DATE .. ` 6.. ADDITIONAL COMMENTS ..IV yfi9 ....../Final Inspectioo-y. ... Date . /._� ....... . SAN JOA1LOCAL _._. HEALTH DISTRICT E. H. 9 1-'6e Pev. SM