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FOR OFFICE USE: APPLICATION Ft SiTATIGN PERMIT ....................... . . . . I/Y Permit Na. .: :. �- •• (Complete in Triplicate) .,>_, � Date Issued .. .... This Permit Expires 1 Year From Dale Issued—- Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described" This application is made in compliance With County Ordinance No, 549 and existing Rules and Regulations: 9�. .... � '_._. •-•-....... . .: ..: . .CENSUS TRACT ....:.:., JOB ADDRESS/LOCATION ... . ... .. - ..... .....-...... _ - ..�;..r,_ _. ,u H ..........................:. ............... Owner's Name .... ..... hone YC , ,,._.. City . ._l!!/�? - t ....license #Qf .' .. � Phon ' Contractor's Nome ....../...M Installation will serve: Residence j]Apartment Housed Commercial ❑Trailer C Motel ❑Other ------- ...... --- --------- ............. Number of living units:.... Number of bedrooms -,e_OZ..-_.Garbage Grinder /� - Lot-Size `1 �� •• Private • s� Water Supply: Public System and name .. f`. _.... -------------•----------...._. s. .... v Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat C3 Sandy loam ❑ Clay Loam ` Hardpan ❑ Adobe ❑ Fill-Material ------------- if yes,type ------------`---...-.--- y_. {Plot plan, showing size of lot, location of. system in rel,4ttion towells, buildings, etc. must be placed on reverse side.} k NEW INSTALLATION: (No septic tank or seepage pit pe mltted if;p blit sewet,i�available within 200 feet;}M - ,� btaterio� .liquid Deptli : ............... PACKAGE TREATMENT ( ] SEPTIC TANK'............Capacity ...-- TYPe '.. l_ / sf�.•• No. Compartments / f �'I _ p. vt• ..... Distance to nearest: Wel .../._f?... .............:.......Foundation /`�....--• Pro Line . ...... LEACHING LINE No of Lines _..... ------ ...... Length of each line .:= --•-:_...._... Total-.Length/" ••-•............ ti .. e th Filter Material ...._.:,_: D' i3ox 'Type Filter Material�.,/ a - p '4 . ,e Yp i Pr Line ..._.. / Z Property i f Distance t ne rest: Well .. .. ._....-•--- Foundation __......_.. _h r ^/ _--- Rock Filled Yes No'.Q " �1 Number SEEPAGE PIT Depth /_ /.. Diameter ..-- ._._. I _ { / ref•- Rock Sixe � Water Tibl�-Depth . ----.......�..... j.. �,. :r ` .'�'�-- .Foundation �,�. .......... Prop. Line _ .::".....•.._._..... Distance to nearest: Well .., � ===- f....._..._....._ REPAIR/ADDITION(Prev. Sanitation' Permit ee 'Dale..,:•.............................. l ................• ------ ' ••--- ...:.........._--.. ...-•--•-••........ Septic Tank (Specify Requirements( - Disposal Field (Specify Requirements) ..... ....... . __.___......•--•-•......-•-.....__......._..__. -- — --•-•---..--•-- ..... . .. ..... 1 ...--- ----••-----------------•--•---...----•-•---•-.._...:__.-----••------------------------------.......... ----- (Draw existing and required addition on-reverse side). I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Herne owner or liters- sed agents signature certifies the following: 6 - --_- --- "I ----"I certify that in the performance of the work far which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed •. --------------------------- Owner BY ------ ••------------- -' 0 er than er) FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY ..... __ ................................................. ........................ DATE .... .. --�----�--•��.......:...... BUILDING PERMIT ISSUED .--------. DATE -------- _..... ADDITIONAL COMMENTS d •---• -----•----•---- ........ ...------•-••---- •-----------------• � --------- ---•-..............._........_..---._................_...................... _ •---.I..... ........ ........................................... _... Date .... f.. ........._....._ Final Ins ection b ---------------•---- ........ ... ............. �! SAN_JOAQUIN LOCAL HEALTH DISTRICT v T � 7/723,414 ft__. Cal