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FOR OFFICE USE., APPLICATION ICOR SANITAY'IQN PERMIT _ o. .................... n (Complete in Trip)#cats) Permit N ........... This Permit Expires I Year From Date Issued Date Issued ..1.' I____ ...... ............ 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 existing Rules and Regulations: �D �1� s JOB ADDRI 55/LOCATION ® .._ ......._-- �... ................�--............_._..........CENSUS TRAGT -----•-----•--••------..._ Owner' Name 2�- Q !" .6f P ....................••-----•-- s ............................:...:.:...... Phone 6�-0/� Address �� ------ Cityr �k , .................... •------- -� -------- Contra ctor's Name -------ZIAg •--•---........'.�A" ...LIcense .....................•-• Phon -- - Installation will serve: Residence KApartirrient Nouse 0 Commercial OTrailer Court 0 Motel ❑Other---............... �� ........ .....:.... Number of living units-------- Number of bedrooms _ 6......Garba a Gri der ma /.sem ..•.. ... Size Water Supply: Public System and name0. ............................. - i -------------- Private❑. Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay p Peat❑" Sandy Loom Clay Loam Hardpan p Adobe$if Fill.Material ............if yes,typ® lot 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 } SEPTIC TANK f } Size........................... - Liquid. Depth . ` Capacity •----•.............. Ty pe ...:.---•-----=----. Material----.................. No. Compartments -•------ [ j Distance.to nearest: Well ---.--R .........................Foundation Prop. Line ............. .• LEACHING LINE No. of Lines .........:.... ----- Length of each line..__..........----------.... Total Length ............................. Type Filter Material .Depth .Filter Material LA . Distance to nearest: Well ......................... Foundation ............ -_---__ - Property Line __.. ............... SEEPAGE PIT O Depth .................... Diameter __...---..:-•-- Number _.-------------------------- Rock Filled Yes ❑ No Water Table Depth Rock Size .......................... Q Distance to nearest: Weil.................... ______ ..:..... .............. Line Foundation .. ... : Prop. .. . --•-----••--.......�- REPAIR/ADDITION(Prov. Sanitation Permits . 8 �..-__•---------- -•-----• Date Septic"Tank (Specify Requirements) ............................... Neposal Field ISpecify Regvirernents) .. _ ____.f_ _ _._-�......... ...........f...-0- -Owl- ......____...__.._................. _ C1riP Cllr' .. .Y Js`l- 1 3 3'!..�C__ ,f'�_. '' _.:1�' ................ .f ....•-- ;S -•"�••-� aw existing and required addition on reverse side I hereby certify that l have prepared this application and that the work will be done In accordance with San.Joaquin County Ordinances, State Laws, acid Rules and Regulations of the San Joaquin Local Health,District. Memo owner or linen- I ted agents signature certifies the following: # "I certify that in the performance of the work for which this perrnit is issued, I shall not employ any person in such manner as to become subject two Workman's Compensation laws of California." Signed __t1�?.r +'�`.#a.�li�.L�.f#_. T®_n-.4W_r. C�... B Y n - er) - f """'{If other than ow • � , FOR DEPARTMENT USE ONLY . { APPLICATION ACCEPTED BY ------- --' ----•----•- -----------•----- -----------•--- A ;....::-BUILDING PERMIT ISSUED . . ------------- -------DATE - -"-- ---r-/---r------ 5 i T10NAL COMMENTS ------ --- - -------------- -'- -- ------------------------*---- ---- -- ...- --------------- -----------------------•-•-----------_.. ... ...__.........................._...._...........,_ __ _ _____ ________.........__..........__.-.-------------------- --...__-._._-..._._ Final inspection by; - 6 -- -----------Date ..._ ._ SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7 , 3M "