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FOR OFFICE USE: - 4 ._.. . APPLICATION ICOR SANITATION PERMIIT t .......... ..................................... . ... m (Complete in Tripllcatel Permit No. ............................. Date Issued .Z�.:.a.z� This _Xtxpres t Your From Dole Issued ff I Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein t. described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: } - JOB ADDRESS/LOCATION .. ... _.�'�_..5.�... . �U��.:.. .....:............................ ..CENSUS TRACT Owner's Name t � - - ..•.................... � s Address ._.�j�C}.b' /t-�-ty.. .�i9 �- .._� � •--••-- -� Phone .... _ • City ...P"TT r Contractor's Name t rens# .� Phione _ Installation will serve: Resid�qce Apartment Hokise_ J Commercial"j�Trailer Court AAotel❑Other................................................ .................... ...----.--• --- Number of living units- .�___-._ Number# of bedrooms --/....Garbage Gr€..der Lot Size_ Water Supply: Public System and name Private E .. -•---- ... Character of soil to a depth of 3 feet: Sand b Silt El Clay 0 Peat❑ Sandy Loam.❑ Clay Loam D .. - o Hordpan[] Adobe 0 Fill MaterlclI .._._._.. .. If yes,type............... .........._. (Piot plan, showing size of lot, ,ocatio of system in relation to wells, buildings, etc. must be placed on!reverse side.) NEW INSTALLATION: IN* septic tank or seepage tpit permitted if public sewer is.available within.2©0-feet,]' PACKAGE TREATMENT [ ] SEPTIC j !xfa,��%� Size.----••-----......_ • ......_-- ..... Liquid Depth .......................... Capacity -M0 1 ...------ Type -6� Materlal.. �No. Compartments Distance.to nearest: Wel! i --•----------------=-------•--------Foundation ......--------,..,.... Prop. Line - LEACH] No. of Lines ................... length of each line_......._ Total Length 'D';: Sox t g --------•-•• . 9 n� .......... Type Type Filter Material ....................Depth Filter Material -.......• - �CI t � Distance to nearest: Well ....:::::::..... Foundation "" ... ,:�.-..� .. ------ .....-- Property�Line --- 5 PAGE PIT p ------------- SEE ET [ I Depth -------------------: Diameter ..........S..... Number ---------------............. Rock Filled Yes [01 No C] Water Table Depth ........:.............I..................--------Rock Size 'Distance toInearest. Well ..................... .................Foundation ... Prop. Line REPAIR/ADDITION(Prev. Sanitation.I.Permit# .._......._.:....._ Date --------------- ---•-•---......._ ••--------------- l Septic Tank (Specify Requirement s _ _ Disposal Field (Specify Requirements) QL �_- • !, $X./.t]__ ..1 N -----------•----••--••--•--••-•-- -- -----•--------- ..................................... ....................... ------------------------------------------------------------1.------------ 2 existing and required a dation an re rse 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, and Rules and Regulations of the San Joaquin Local Health.DisFrct. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for 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.,, k s. _:I Signed ----------------- •----•---- -----••--- --------------- Owner BY ................................ = - rine .... Of other than owner) FOR DEPARTMENT USE ONLY, APPLICATION ACCEPTED BY_____. ----------- --I... . ...:...................... ....................... ._...- DATE `-. BUILDING PERMIT ISSUED ______________________________ ......................... ... . - ADDITIONAL COMMENTS ---------------i._-._....._.__.. ----------------------------------------------- -- •- --•------•--•---• ----- Final Inspection b - • - P Y ....----........................•---•-- .--Date . '7�---•--•-- ---•---- 13 24 i 5A�NJ O LOCAL HEALTH DISTRICT 8/7h 3Mf