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FOR OFFICE USE: APPLICATION SANIMION PERMIT � ' S X to In Triplicate! Permit No. ..�....-•---...__. ..........I................................. ............ -a s` s- This Permit Expires 1 Year From Date Issued Dam Issued .. ............... Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 519 and existing Rules and Regulations: JOB ADDRESS/LOCATION .._....... i`,l ...CENSUS TRACT Owner's Name ; 4- 44- .......... V •�p��Z,.r ,..-----••--�'! - �i�u•• - _ .....__ Phone .. Address ............11 .&..;,K, r=city ' a. b=X :._._ a�!aK. _ ._.License . =3 ..__, Contractor's Name will serve: Residence[]ApartmentMouse 10 Commercial❑Trailer Court (j r—;=74'Moiel Q Qth,,�er-- ......... = ---•-•..... Number of #w .. ing units:....... ... Number of bedraoms .._.........Garbage Grinder ....... Lot Size ............... .1 ............. Water Supply: Public System!and name �' ;.�-�� ...-__--•-�----._ -Private ❑ Character of soil to a depth of r3 feet: - Sand 0- Sllt❑ Clay ❑ Peat❑ �'5 ndy Loam ❑ Clay Loam ❑ ------ --.--•-�..�.�Hardpan[j...- -AdobeFill Material ........� If yes.type......- •t.... ............ 1 . (Plot plan, showing size of lot, location of system .inL relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit p±rmitted it pub!€c sewer•is available within 200 feet,j.r r..r__.__ _ L PACKAGE TREATMENT j j SEPTIC TANK{ j Size.......................... Liquid De .......00 + Capacity -------------------- Type ---•------........_ material...................... No. Compartments ..---........._....-.-11J Distance to nearest: Well ....................................Foundation _.._... .............. Prop. Line .........-_..__..--._. a i LEACHING LINE [ j No. of Lines........................ Length of each line.................. Total Length ............................ '©' Boxy`.........._ Type Filter Material .....'...:... t^. D`epth Filter Material �`: Distance to nearest: Well ................ Foundation L... Property Line SEEPAGE PIT { j Depth ......... .......... Diameter Number ............ .. Rock Filled Yes ❑ No ❑ Water Table i Depth ................................................Rock Size ._..------=--•---..... Distance to nearest: Well ........................................Foundation ---_1............ Prop. Line ---.>.............. REPAIR/ADDITION(Prev. Sonitation Permit# ............................................ Date ...._...... ....... ..._.._._..__.} Septic Tank {Specify Requirements] .............. .... ...._...................j� . Disposal field (Specify Requirements] *•%r =: � �=r x � --1 --•---• I ------•-••••----•-•------_....- --------------------•--. --1 --• ................................................ ................................................ - ........................ ----•-----•------------ I--- j (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 San Joaquin Local Health;blstrict.''Home owner or licen- sed agents signature certifies the following: !'I certify that in t90 performance of the work for which this permit is Issued,.1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed -------- ------ T--- - -----..--•-------•--•--'................ Owner BY ' -------t` ` 4 � title - -------- ............................. (If of er an owner) i _ 4FADEPARTMiENT USE ONLY APPLICATION ACCEPTED _._. DATE .Y.-� --------- ........ BUILDING PERMIT ISSUED. .._..-------------- ---- ------- - DATE ADDITI NAL CO/VI ENTS ------------ ---------------------------------------------- -----------•----._.... --- _...--._.._ .......... ---- .. .-- ------------------- -----------------------•-----"._ ._ ..--------- Final Inspection by: �f/a_..�r��L. h... � ...�pr1.P. e�9�- Date . .. �.r EH 13 2a 1-58 Rev. 5m SAN JOAQUIN LOCAL jlIEALTH DISTRICT 8/711 3m r