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• i �u r APPLICATION FOR SANITATION PERMIT FOR OFFICE USEt (Complete in Triplicate) Permit No. Dote Issued �-•''�- 'y This Permit Expires 1 Year From Date Issued Application I,• r,-I . •, i i.• to :hn Son Joaquin Local Health District for o permit to construct and install the work herein described. This oppl rnt,c, I:• ,,,iphonce with County Ordnance No. 549 and existing Rules and Regulations: JUB ADDRESS IGC V AT _!. - V � CENSUS TRACT Owner s Name -1✓r-. ;:.b/r J1, r c Z. �`.�' ,.......: + Phone 1 .4 le .e . 'Address . 17, CitZip Cant.actors Name .. . . -<�te. /' �•�- License ef` silts: C Phone InstollLtion will %,erve Residence Q Apartmer,: House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units. / Number of bedrooms Garbage Grinde Lot Size l - e- !� - Water Supply: Public System and name ._ Private Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Cloy Loom ❑ Hardpan Adobe❑ Fill Material ,If yes,type (Plot plan, showing size of lot, location of system in relation to wells, buildings,etc, must be placed on reverse side.) �n NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( I SEPTIC TANK [If Size -11 Jai l..W ... ..Liquid Depth 1 .. O Cupocity Type U-4twr/ Material .2'r>s-C. No. Compartments ....... Distance to nearest, Well /L1./ Prop. Line ?.f ....._ ....� LEACHING LINE (;j No. of Lines _ . . . . Length of each line . ..... Total Length I'2el _. 'D' Box I Type Fllter Material. .S,L..... Depth Filter Material . � . ._ .. .. . . ....._ Distonceto nearest:Well 147ele Foundation ..Property Line SEEPAGE PIT ( q Depth .i?g/'z. Dtometer ?+' .. Number ...,.?i ._. Rock Filled Yes Q� No❑S -, fAvL Water Table Depth___ . ... 141f r..._. . . ..Rock Size.../�3X .?... . __.. _.� p 4 Distance to nearest: Well /„>>!�C/....__. Foundation Prop. Line i J// REPAIR/ADDITION (Prev, Sanitation Permit$ _. . .Date .. . ._. ._ ) Septic Tank (Specify Requirements) ............ ..... Disposal Field (Specify Requirements) (Draw existing and required addition on reverse side) 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 Son Joaquin Local Health District. Home owner or licensed agents signahre certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ sny person in such manner as to become subject to Workman's Compensation laws of California." Signed ! Owner By '�'y.':.w:/#�. (pc r.1lTiile Uc .,�-_r-e 4.s• ' (if other than owner) d _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � _ r —Gr�r.�C/ DATE 3 — 3— '7 DIVISION OF LAND NUMBFa DATA ADDITIONAL COMMENTS Final Inspection nye / Jc �I' C�y'�� `��/ Date �jt ,.e L7 / FH q 24 SAN JOAQUIN'LOCAL HEALTH DISTRICT ter+s[v 1174 sM