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e ZIP* A e e � ? OFF;CE USE - ' <sYYuCATION FOR SANITATION PERMIT Permit Na. G (Complete in Triplicafo) hate Issued - This Permit Expires I Year From Date Issued ^plication is hereby made ti the San Joaquin Local Health District for a oermit to construct and install the work herein !ascribed. This applitarion is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: -'08 ADCRESS./LfI 1C N Z f9C�. .d <-' . CENSUS TRACT _ .. _. '� . .. .. .. �[s_ ..... � •- �•. :' .<) J. .'. � ..._... . . Phone . .... ..._... . ........... _._ Owner's Name .. .... Address ry _. . _ .,._ ._.._._.... .a .License # i`-' Phone r/[ _ _..:.....,... Contractor's Names .. .• t n- .. /- �. . - .. . -- Installation will serve: Residence Apartment House❑ Commercial Trailer Court 0 Motel M Other .. .. _. ......_...._............. " N-Jmber of living units: , Number of bedrooms ..<.,.....Garbage Grinder Lot Size Water Supply: Public System and name . _.__ _ . . _. ........ ...... Privafe� Character of soil to a depth of 3 feet: Sand❑ Silt O Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Tg. 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.) NEW INSTALLATION: INo septic tank or seepage pit permitted if public sewer is ovailable within 200 feet,) V Size.. . _- Liquid Depth ..__....... ........_. t PACKAGE TREATMENT ( ] SEPTIC TANK[ j � -��•��- - - "" � - a __ Material. s Capacity _. _. .. Type _.. No. Compartment _.. . Distance to nearest: Well ...... ......... ..__..Foundation . ._ __.. Prop. Line ............... LEACHING LINE .. .. Length of each line __ ___ Total Length .................. [ ] No. of Ones � 'D' Box Type Filter Material .....................Depth filter Material ...... - y Distance to nearest: Well .. _......._.._.._. . Foundation __ Property Line .......... AGE PIT [ J Depth _.. Diameter Numbe• _._ _. ............... Rock Filled Yes ❑ No Q frrD — -— Rock Size ' Water Table Depth ..__. ��"""""'� ' ' ......... ............................ Distance to nearest: Well ..... .... . ....................... Foundation .................... Prop. line ........._.. REP/ .IiON(Prev. Sanitation Permit# .. .. .. ................... . Date . ..............................-1 .... ............. ......................rt'„? ... .. ... xptic Tank (Specify Requirements) ��--- - .... 3d,', �_._•..._ ? D;sposal Field (Specify Requirements) ...... _..................... r . ....w.�. A.. ... (Draw existing and required oddMon on reverse side) I hereby certify that I have prepared this application and that the work will be aloe It accordance with Son or lice n County Ordinances, State laws, and Rules and Regulations of the San Joaquin tocol Health District. Herne owner or Iiceo- sed agents signature certifies the following: le an person In such manner "I certify that in the performance of the work for which this permit is Issued, 1 shall net emp Y Y as to become subject to Workman's Compensation laws of Califomia:" , , . . Ov.ne• Signed .., - title B y i,(If other than own-) M v FOR DEPAPTMENT USE ONLY DATE APPLICATION ACCEJTEr' B" ...' -- - _.DATE - BUILDING PERMIT ISSUED - -- - 1D ..... .. - - . DITIONAL COMMENTS •-- ' t ._. __.. pp. . . °lnpl Inspection by T/t•L SAN JOACUIN LOCAL HEALTH DISTRICT