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,.�Rnes,; rr��1II±V`�IY+/r c •.r...,-4Z•v ��.-.n.7)i'V5rl'99i3Sr{;f►WS'YC ' 4 !, X. FOR OFFICE USE: APPLICATION FOR SANITATION PERM iPermit blo. •••• - kI .................................... (Complete In Triplicate) ..._................................................... Date Issued .............................. ......................... This Permit Eirpires 1 Year From Dab Issued <; Application is hereby mode 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 existing Rules and Regulations) JOB ADDRESS/LOCATION -.c Q. .�Q. Y-N---)4.... .. .......... ............ ..CENSUS TRACT ............. Owner's Name .... ....Phone �a..c.1.5.----...-Ver-�-.t��.r..Y.YZ.�..l...�.�1............................................. Address 0.� �.. J9..1'erg_A....................................•--••-City ..�S.C. . .. .....- ..............-.- . _.............. ......-.... .. 'Y : 1... .Q- 9-7.7/`�T.... Phone License Contractor's Name _ O(S-0. Installation will serve: Residence®Apartment Housee Commerclal QTraller Court fl e Motel QOther/% f•--... �iIEC��.--•• Number of living units:.1...... Number of bedroom------Garbage Grinder/-V o..._ Lot Slze .-9-3......�.�..1 £.S.»-•-». Water Supply: Public System and name ................--..........__...................-- ----____...__-------------- ..................Private Charocter of soil too depth of 3 feet: Sand O Silt❑ Clay ❑ Peat❑ Sandy Loam Q Clay Loans Q Hardpan Adobe j� Fill Materlal ............If yes,type ' pa ® »..._.. .t (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be pfocad on revette ski*') ' NEW INSTALLATION: . (No septic furl, or sonpage pit permitted if public sewer is available within 200 feet,)// �'•� z T Size_ l2_s2.4.._ g L.--._ Liquid Depth ..a-•-7=�- x PACKAGE TREATMENT [ ] SEPTiC .ANK( ] _._._ .Tf• _ Capacity 12.0-0...... Typeo&.�J _ 1Aaterial_Co.-!7.G.ft�.� No. Compartments - Y Distance to nearest: Well -� _ �T.__Foundation A_r7 .-• . Prop.Line�QLZ'£-r 'i No. of Lines 'Z.. ._ Lengt! of each line.....`3._Q.............. Total th /.�.C]».»-»�». LEACHING UNE [ ] Q L 'D' Box ...I....... Type Filter Material IyZ....Ii S.t�._Depth Filter Mpbrlal ..... .. .. .. . Gistance to nearest: Well ... .._ Foundation Property Line �Q�?.-�T»•w•- u 2 Ile to �Q- .--•. Diameter C.. Number ........�....._._..... Rock Filled Yes Na r y i ) P Water Table Depth .......... .................Rock Size ..... Distance to nearest: Well -_� o._{' .............. .._..Foundation 9.P. .... Prop. un* .lL QQ Date . _..../.b..-!�:(�..........) REPAIR/ADDITiON(Prev. Sanitation Permit¢ •••-.......•••••....._..._................... D�� Septic Tanis d Requirements) /.�__Q_.Q......6... Gl c�c�.>X ...».. .................._..._..._...—..».._.»».». I� fy eq ..._--. ». _ ...............:.-...__....._.......:.... isposoi Field (Specify Requirements) - -•--. ; ................................................... �.....- »...»..».:.. ............................................................ (Draw existing and r uired addition on reverse side) u If beeeby certify that I have prepared thk application and that the work will be dense In accordance who Saw Jeagdw w County Ordinance*, Stab Laws, and Rules and Regulations of the San Joaquin Local Heohh ,'%Md.Hoene eweter.K pr�A• eed agents signature certifies the following: In such enenatee "1 certify that in the performance of the work for which thin Pwmlt Is lsswW' I shall net employ any person as to become subject to Workman's Compensation laws of California." Signed....................................................... .. Owner �L�..�-C'-S__L.IL �l� itle ..-....--. Q.iI d I .C. ...�..r............... (Ir other than owner) DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY.-.- DATE ./ /w - , BUILDING PERMIT ISSUED..........-. : DATE_.. d� ADDITIONAL CCMMENTS �!-...................................... ..................................................... ................................................................................ ....... ....................... _ Date- . Final Ins ction b , ...ra-Ag Pe y i : Edi 13 2h 1-6(1N S.ZkN JOAQUIN LOCAL HEALTH DISTRICT g�74 ' 3M (r •�o