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FOR OFFICE USE:
<br />APPUCAMN FOR SANITATION PERM
<br />............................. ................... (Complete in Trlplir al:r) hnv*Mx 7.
<br />` ............
<br />w.«...�......... `........................... This P*mlt Eapiras 1 Yrwr it mm Date, llssuW brain issued ,? Z- �
<br />,application is hereby ttiade to the San Joaquin Local Health District for a permit to contiruc► and install the work herein
<br />described.. This application Is made in compliance with County Ordinance No. 549 unci existing Rules and VA*utatiorw
<br />JOE ADDRESSAOCATiON ....yt' . .. . .... .1 ..... ,.�. ........ ............... i.FWSW 11100-
<br />------ ----
<br />Owner's Name ...7ISr_,e3 .✓...................... ....t�artrt
<br />Address .......... ._...._............ .....C I f Y. 2,
<br />,r..
<br />Contractor's Name ...1. _J .Lita»sca 91t ,, �,z✓
<br />Installation will serve: Residence [X Apartment House C] Commercial Orraiter Cao a
<br />Number of living units ........ Number of bedrooms.. ..».iaCtrlatsge Grir�r' %�✓.1?. ,. 11s! Sin ...,. ... .: �......
<br />Water Supply: Public System and name ...........�..,,......¢..........w........._...._ ....., .................. ...........,....,..:...privata or
<br />Character of sail to *depth of 3 feet: SwW 14 S*O Ciay Q P001`0 Sandy Loam {3 Clay Lo m p
<br />Hardpan ❑ Adebe o iii liaterlol ............ if V69, type ....... ................. .
<br />(Piot plan, showing size of lot, location of systems in nkitlen to wells, buildings, sic. must bre placed on reverse side.)
<br />NEW INSTALLAII'IOH. (No septic tonk..or seepage pit permitted if public sewer is avoilaldre within 200 feet,)
<br />PACKAGE TREATMENT f I SEPTIC TANK( l Size ................................................ Liquid ihiati+r f
<br />Capacity ................... Type ....--------------_ Material ...................... No. Coo�nents .....�.
<br />Distance to nearest: Well...................................hop, Line ....,.................
<br />LEACMNG LINE t j No. of Lines ........................ Length of each line ............... ........ Total Length ..............,.........,,
<br />V Bons, .............. Type filter Material ..........:........Depth filter Material .................... ,................
<br />Distance to nearest: Well ......................... mandation ............... , ..... Property line ....... ........_ �
<br />SEEPAGE PIT ameter Rods filled Yet 0 NWO 01
<br />� ] + .................... ifli ..._.._...__..,.. Number ........,...,............,.. . .
<br />WaterTale Depth .,............. . ................................hack Size ................................ r
<br />Distrre to nearest: Well ........................................foundation ..... ,...,......... ISN ............... .
<br />REPAM/ADDMON {Prev. Sanitation Permit #............. .............................. Ids .., ......,....,.....,..._.,__,j
<br />Septic Tank (Specify Requirements)......................w.,............. .»......................... .......,..._ _.,..,............... .......
<br />Disposal Field {Specify liequirememtsl .................... ....,51.%"�........-:• o !-....,...� , ... _
<br />..,,......_._.� !
<br />........... ,0. ...... s✓ A Y& ..... ... ........ ........ .,.......... ....._.........,.,......................_._.............,,_.......,......,
<br />(Draw' wthWa q and required addition on reverse side)
<br />I hereby codify that I hnvs prepcsred lialit application and that the wok will tae dame In acemdaants +wrilh San Jeotfula
<br />County Ordinances, State Laws, MW avies lensed Regultrt Ons of the Sear► .ics"viar !acral ifwulth. DISMd. Home owl VW or ilew
<br />sed o9onts signature codifies the fallowing:
<br />"I certify that in the performance of the work for which this pomit is i wood, l slum not omploy tiny pe:w"" In •svcll% mom ww
<br />ors ter bece►mo subled to 'Wwkman's Compensation laws of California"
<br />Signed............._............_._.. , ..--- .... .......... ..... Owner
<br />BY...............�f eat! r than ovine _ .......... Me ...... r• ............... .......
<br />l
<br />USE
<br />BUIL CATION AC CEPTEt1 BY ......... I .....- DATE . ..I .'
<br />BUILDING PERMIT ISSUED ......... �........... ....-.-.. ..._.............�.__ ...................., .DA,TE _....................
<br />....................... �.,...._...................... ........ ., ..................
<br />ADDITIONAL COMMENTS .................... --
<br />.ca( Inspection by, _.................
<br />' ......� ............................................. ...'.................. rr....�
<br />Date
<br />EH 13 2L 1- 8 116v.� SAN V.N LC)CA! HEALTH DISTRICT 8/7� 3M
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