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FOR OFFICE USE: I APPLICATIOI`� FGR SAPJITAT.ION PERMIT .. . ... Permit No. ...r�..s.��oY3 - _.... . (Complete in Triplicate) �� 7y i ...._..._ ................._.... _ Date Issued _....�...."..-.. - .. This Permit Expires t Year From Date Issued ruc, and e -work rein it to consl described. Thlication ishereby application is the made In compliance in cal with Coualth ntytrict for a DOrd nonce No, 549 and existing Rules and thRegulations: JOB ADDRESS/LOCATION 700.. , S�uJ�G.S..n f� __. .......... CENSUS TRACT ... .. ... ... ... Owner's Name .L E e_ . C.3�.U�rl.?,`H/ ........... . ... .... . . ....... Phone ..�.Q".. .7.3..f.... /p� DD _� .. .... ... ... Address22_�L.O..Q_�-Sc2tU�C'.S. /1,�• .. . City . l,..e G.m o . ..._... Contractor's Name ............... ..License # . . . _.._ .. Phone .............................. Installation will serve: Residence E]Apartment House❑ Commercial ❑Trailer Court Motel ❑Other ............................ ............... Number of living units:..../..._.. Number of bedrooms ......Garbage Grinder ....._._.. Lot Size _.........-_.... ..._......... ........... .. . Water Supply: Public System and name ..'L".kT..V..52.�er.---------•..................._................................................ ...Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 2Y Clay Loam ❑ Hardpan❑ Adobe ❑ Fill MateriaWA s..tlf yes,type............................ (Plot plan, showing sizo 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 [ ] SEPTIC TANK[ ] Size.................../.... . Liquid Depth ......_............_.... O Capacity %9.,oc, Gq_/, Type 0.............. Moteriolf1 vcYGfc-No. Compartments .................... d Distance to nearest: Well ../..7s.. f-----••--- Foundation ...................... Prop. line ..-................... No. of Lines Length of each line._.O.0 .._.. ..... Total Length .42A/.G.............. . LEACHING LINE [ ] -��--�--��--- 'D' Box ........... Type Filter Materipal/w.Ck./...fa2 Depth Filter Material ...I.�.#.to.'............q................ Q Distance to nearest; Well ../.7 .T f...... foundation .1...ft.....- - Property Line ...5.i..F............ _ SEEPAGE PIT [ ] Depth _ .... Diameter ................ Number ..._.._..._.............. Rock Filled Yes ❑ No Q .Vater Table Depth .. ..Rock Size ..... ...._... . ..... ..... . . .... ........................................... Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# .................................__.._.. Date .... _......................I Septic Tank (Specify Requirements) ... ......... ......................................... ........_.. ................... .._............................................ Disposal Field (Specify Requirements) .....__.._.. .... ...._... . _..................................... (Draw existing and required addition an reverse side) I hereby certify that I have prepared this application and that the work will be done :n accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. 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 subjectjJa War an's Co p nsation laws of Ca lifurnia." Signed ,GL_�4 -_. ____.__._...._. _._.. Owner By ..__ Title . _ . -....__. _ .. .. ........ ,If other than owner) FOR DEPARTIRFNT USE ONLY — APPLICATION ACCEPTED BY . ..... DATE . J'�• BUILDING PERMIT ISSUED _ DATE .._. .... ... . ......_. ADDITIONAL COMMENTS - - - - - -" - --- .... __ Doh: