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OR OFFICE USE: APPLICATION FOR SANITATION PERMIT j Permit No.27.�aU.,3.... ............................................... (Complete In Trlp�Icate) -7 Date issued .3- F I I - this Permit Expires I Year From Date Issued � ...................................................:.... Application is hereby made to the San Joaquin Local Health District-.1 or a permit to construct and install the work herein t described. This application 1s made In compliance with County Ordinance No. 5a9 and existing Rules and Regulations: JOB ADDRESS/LOCATION .I�. l...........1.!! '+� ..:. ..60. , 4r?/��:. .. �►: ....................CENSUS TRA,/CT .........................: 4 �N pp c Q, a.d .! ' 1. .................... Phone ..fie~. 7ci ......:._ Owner's Name ... Qlti�.._F_ ./4.�.?f .............. Address . � �. ,�.r.. al �� _ .... - ....city . ja .................... 4,�s2 ..:.. `` Phone ... Contractor's Name •. ' -:t.�s ..._.....�QIL. ---=��..:....Lioanse . 7 . .. 1 l� Installation will serve: Residence 0 Apartment House 1D Commercial laTrailer Court ❑ Motel 0 Other........:.................................. re .Garb fly a Gri der Lot Sl��` F•... ....................�� Number of living units,............ Number of bedror'ms/ �9 fj L ..-- - r/ L. �S .. . .T. � .lid . ..... Private ❑ Water Supply: Public SystemN and name ... ........................................... Character of soil to a depth of 3 feet: Sand 0 Slit 0 Clay ❑M Peat❑ Sandy Loam ❑ Clay Loam L7 Hardpan r] Adobe Fit l Material ............If yes,type............... ........ ... ` $plot plan, showing size a :lot, location of system in relation to ,wells, buildings, etc. must be placed on reverse alds.� NEW INSTALLATIONS (Nog pit permitted septic tank or seepage e it d if .public sewer is available within 200 feet,) • ` I PACKAGE TREATMENT I ]i I SEPTIC TANK� ) Size......E�.....:.......• .. ...... ... Liquid Depth ....................... Material. Na. Compartments ............... Capacity .................... Type --.. ................: .. .........Foundation ...................... Prop. Line ............ .. ... Distance to nearest: Well �� of Lines .............•--...... Length of each line............................ Total Length ....................... LEACHING LINE [ ) No' -- '0'�IiBox ............ Type Filter Material ........ . .........Depth Filter Material ..... Distance to nearest: Well .................... ... Foundation ........................ Property Line ... .............. Diameter ................ii.umber ................_........... Rock Filled Yes 0 No SEEPAGE PIT [ Depth .................... W�te► Table Depth ................................. .1 ..........Rock Size ...................a............ ...........Foundation ..... Prop. line Distance to nearest: Well --•-•.................... -......._...... ................... r � _ REPAIR/ADDITION$Prov. Sanitation Permit# --- ©ate ................................) Septic Tank (Specify Requirements) Z.�!.Q:� �� /QQ�--.... /. ��_1......... `.. ....... 11 ?` ... ...CJ� .......... j :............. XDisposal Field (Specify 1'Requirements) . .,fir- .... .. . . ..............il. ........•••. .......--............................... :� ............_....................................................................._....... la IP �N ................................. _.................................. ...................................................... ......... •- � (!]raw existing and required addition on reverse side) I hereby certify that I have prepared this application and that 1&0 work will be done in accordance with San Joaquin ( of ttio San Joaquin Local Health District. Home owner or lice ft Ordinances, State Laws, and Rules and Regulationsrt ~ sed agents signature certifies the following: I "I certify that In the perFo mance of the work for whlth this permit is issued. I shatl not employ any person in such manner as to become subject to Workman's Compensation laws of California" Signed ........ ,� It ...... � Owners B ............... G! ?�!M. ...... . . .. -.......... 7itla ....-.......... Y ` $if other than owner) i ' FOR DEPARTMENT[ USE ONLY .I E .. DATE ....7 ..or .!r!.. y7........::_ ........ ..... ... ... BUILDING PERMIT iSSU1:D$Y ............... ...,. APPLICATION ACC EPTEQ .h DATE ADDITIONALCOMMENTS ...................•---.....................- .'M............-.........-.... .........--.. ,...... . p- -----........-............ ....•...............---.......... -.............. 'i . ......... ...........-...--.................................. ........................... --- -- - ... ..�. ......---- it __ i pate . .. <, -� ........... F Final Inspection ........ .-.. ........ ..... EH 13 24 1-60 Rev;. 5H SA AQUiN LOCAL J HEALTH DISTRICT 8/�?)t_ � E : .