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FOR OFFICE USE: APPLICAT10hR ANITATION PERMIT .. Permit No. - [1--. - ------------ ---- --- 3. }- {Complete in Triplicate) -"".-_"" ,_" . Date issued --��- . This Permit.Expires ]Year From Date issued e work Application is hereby made ltothe ®an complliancecwithal eCounalth QtytOrdir+ante No. 549 and existing Rules rmit to construct and talndhRegulationsrein described. This application I _._CENSUS TRACT ----------- JOB ADDRESS/LOCATION .T-- _T!u-5f�/ Qf1.j)f - Phon i Owner's Name _____ 9 _ , --------- ------------------------- -------- --- .923-- ------- ------------- - ► -----------. cit �1A�✓T cA-----------------------------------1-------- ' - ra?A. `------------ -- Y Address ---- � Phone4 .3 r � ----- - I l s t _� License, Contractor's Name _. -_-�� - ---- --- -------- " s i Residence �artment House'[] Commercial :C]Traile�Court ❑ ; Installation will serve: t W Motel ❑Other ------------ -- --------------- I Number of living units:___ __--.___ Number of bedrooms - _ ______.Garbage Grinder_-- --__ Lot Size `I-------" . -- - ❑ Water Supply: Public System and name _�____ --------------------------1 -I t Cl `-Peat❑ Sandy Loam ❑ CloyLoam ..0 Character of soil to a depth of 3 fee#. Sand,' Sit ❑ f ❑ s i t• Hardpan ❑ Adobe ❑� Fill Material-��t�-`-`If yes,,type - I ' i (Plot plan, showing size of lot, location of, system in relat�n to wells: buildings, etc. must be placed on reverse side.) �. + t I it ermitt d if public sewer Is available within 200. Itfeet,) A NEW INSTALLATION: (No septic tank or seepage p P i P �; it 9 X. i `� PACKAGE TREATMENT [ ] SEPTIC TANK'[ Size-- __ -- -- - Liquid Depth - ---------•----; F + � p� YP --__ _"" Material ��`� No. Compartments Capacity _ --- --_I T e - -- i } t .10' Found ation �-------------- Prop. Line -----=-- Distance to nearest: Well - --"- I f f .. f �.� ---------- Length)of each line---7_6--- Total Length-rp - _LEACHING LINE [ No. of Linesd I- I t o 'D' Box z ---Type Filter Mat�rial pCk--------Depth Filter Material _�-I---.---- s ' ; ' -- Foundation _# ____------ Property Line47----------`---••- Distance to nearest: Well ________________ --- Qe Depth -" Diameter _______ ____ ___ Number _.___ ." __ ---------------- Rock Filled Yes ❑ No I❑ SEEPAGE PIT [ 1 P ------- ------ ` d ---------1 -----------------RockSize -- Water Table Depths ---------------- ------------------------- t •--- } Distance #o neares#:`Well -------------- -- - -- Foundatibn Prop. Line --------------------• - [, # REPAIR/ADDITION(Prev. Sanitation Permit-#- --- -------- f (Specify ; A •___________________________ _ __________________ eiP ' Yeqi es) _ ------------------------- ___---. - -------------- ------------------- - ----- 'I 44Z . 5. Qsposal Feld (Specify Require ments] ----------- R `a-- lI -------------------------------------------- - -- -- _ j--------------------------- -- -- --- - ---- ---- --- -- --"-- " - --�� (Draw existing and regVIie Taddition on reverse side}� I hereby certify that 1 have pre ared pthis application cii that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regullatibns of the San Joaquin Locale health District. Home owner or licets- ti sed agents signature certifies.,thi�following: "1 certify that i tie performance of the work for whiA this permit is issued, i shall not employ any person in such manner as to became.su�l5ject fio Workman Compensation laws of California." Owner -------------- r t _ Title BY "" -------- -------- _ "t f other than own-- �"` y """ FOR DEPARTMENT US i E ONLY � �`,� . .---- �`�--'-.-Z-�-�-�-------- APPLICATION ACCEPTED BY --------- ---� -------------------------- ------- DATE -DATE ---.`..'`. ------=-------- -- ---------•------------ ----------•---- BUILDING PERMIT ItSUED._..�.�..— .----------------------- ------------- ------- ----- d -- -- ------- - r---------- ADDITIONAL ------ADDITIONAL COMMENTS -- ---- --- - - ------------------- ------------------------------ ------- ----------------------------- ----------------------------- --- ---------------- ----- ---------------- --- ------ Date Final Inspection 1' P1- SAN JOAQUIN LOCAL HEALTH DISTRICT m E H. 9 1-'6$ Rev. 5M :_