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FOR OFFICE USE: APPUCATION FOR SANITATION PERMITo Q7 ,Permit No. ..7 -- •• (complete In Triplicate] f*)�� N 7 //- ✓ • -/VG' Date Issued ./......... ._. This Permit Expires I Year From Date!'sued .........._. .... .. ._........_....---- 1 . gpp{imtion is hereby made to the San Joaquin Local Health Districwfor a permit'to construct and install the work herein described. This application :s made in camplian a with County Ordinance No. 5494tnd existing CRS s and Regulpttoris: �o. er«rr!...�itvtll�?nr. ,f M,7!c,�r CENSUS TRACT -........ . ... ... JOB ADDRESS/LOC A�1 ON p ...... .......... I JO ./ �w. N .. .. ............ ._ P`6ane ... Owner's Nome .. p /y /e' h � G lJfPK7v/2 fJ/allfc'...t 14 t........,at. �... 5 .. ! .... .. . ........... Address c� �P/ �• Controdor's Name . ..C:.Y.•.~ • 6� ...............................License Installation will serve: Residence Q Apartment Housc O Commercial QTrailer Court D Motel Q Other WOW- � ...... n�,� 2 ..Gorboge Grinder _-- _. Lot Sizef 1 .VC.. ...... Number of living units:._...(._ Number of bedrooms Private 0 Water Supply: public System and name .. ........................ .......... . .................................... Character of soil to a depth of 3 feet: Sander S{It4 Clay Q Peat❑ Sandy Loam (� Clay Loam Q Hardpon o 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 sower is avoiloble within 200 feet,! PACKAGE TREATMENT •[ ] SEPTIC TANK j ] Size....... .. ¢^- � •- Liquid Depth ....... :--', ty /�f70_ ,. Type {/�!ir? Material. No. Compartments ...................... Capacity .. ILIVr �1 Distance to nearest: Well _...-.. Q..._. ............Foundation..l..P....__.•: Prop. Line .,••-•--,..._. LEACHING UNE ( ] No. of Lines .--.- - --- - Length of each line.....72..�.._........ Toto! Length ,L �•----•••••----• 'D' Box . .......... Type Filter Material T.. ..'.&--•Depth Filter Material Y Line ' Distance to nearest: Well ..._................... Foundation [ J Diameter Number ..._.......—............ Rock Filled Yes [] NO 0 SEEPAGE PIT Depth Water Table Depth ....................•...........................Rock Size .._.............._....Pro {� . ................... ..Foundation _.... .. ......... Prop. line .............. Distance to nearest: Well .... ... :....... ........ p,.` REPAIR/ADDITION(Prev. Sanitation Permit ........ ................................. Date .. ........_..:.. ...............5 uirements) .. ...........»......................................................................_............._................ $optic Tank {SPecify Req •••••^'-^-"" ........................ Disposal Field (Specify Requirements ................ ....................... ........................................... ............ .......... 1 ..........__.........._........ .... .. .. ............_....,................................................................. ............_........r.......... .. ................_..........-..._........-........ .. __.............................................................................._..................................................... (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this applitotion and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin tocol Health�I3tnct. Home owner or licen- sed agents signature certifies the following: "1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in suchmanner as to become subject to Wo man's Compensat_ion.laws of California." Oweer Signed " By (if other than own r[ FOR DEPARTMENT USE ONLY .��,ss ��1�"'_'.. DATE.lC .. .... .........�- .... APPLICATION ACCEPTED BY..... ... ................ DATE ............... ---................................ BUILDING PERMIT ISSUED ._...... .._...... ... ........... ...._.... .............-................. . ... ... _....................................._.. ADDITIONAL COMMENTS _........................ ..... ............ ..........................................................__....__. . ... .. . /� �/ ...... ........................... . .... . . .. Date Final inspection by. .. .. ... . SAN JOAQUIN LOCAL HEALTH DISTRICT • .. .. n I 'ADD—, SWI '