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FOR OFFICE USE; ION FOR SANITATION PE=RMIT _ APPLICATION , Permit No. �..._...7.•!.- • (Complete in Triplicate) .. : ._ .-�j.�... _. .•---- Date Issued -_5 This Permit Expires 1l Year From Date issued Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work herein described. This application is made in compliance with County O finance No: 544 and existing Rules and Regulations: w _ f � �� cZh .rl...........- CENSUS TRACT Jos ADDRESS/LOCATION "Po7ne �. T...- ...� : ......... Owner's Name .... t . Cit Address ....... .. +� ' � G°...1�:.[�lR:Tf.!'1_��.� .__..._..._ ...---.License # 05.�=��..r�.�•/---. Phone Contractor7�"�_....-•-- - ........ s Name .- ,. Installation will serve: Residence Apartment House❑ Commercial []Trailer Court 0 Motel ❑Other ........................•-----._......--- -- / 164 X1 . ..._._..... Number of living units:-_-j__..._ Number of bedrooms _.. ...--Garbage Grinder _._..-__.___ Lot Size . .. Water Supply: Public System and name _---•-----------•-••----------------......... ----------•........_..------- ........- .......................Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ 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.)w kr' NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) Size.••......... .. , 16 Liquid Depth ..... ACKAGE TREATMENT [ ] SEPTIC TANK[ ] - --g---••-•-- ' ' � - r r� Materiel.1:.1�rri�'�---• No. Compartments ..-. ...-•••-••0 Capacity fv1 •--- Type , _ e - -• I Distance to nearest: Well ...Foundation the_ __'•---• Prop. Line ..A0VkX....... .... Length of each Eine._ !� Total length /�.. .... -- ' LEACHING LINE [ ] No. -of Lines 9 -- • -- - D' Box Type Filter Material fix. -Depth liter Material ....-.-1- •-•-----••--•••• --•• Foundation ..__./. _ - .'- .. Property Line ..�� .. ......... Distance to nearest: Well _; ?�,--•i• - '- i ' ,�f'• Diameter ., ll? Number ..------ Rock Filled Yes No Q SEEPAGE PIT [ ) Depth ..... -- -J , Water Table Depth __ �j f-------------------Rock Size --•--• �--�� ' ------••--•--{ A Distance to nearest: Well ..Foundation •..�Q Prop. Line ... REPAIR/ADDITION(Prev. Sanitation Permit# _.................................••••... .. Date ............I..................... 1 f Septic Tank (Specify Requirements) .............•••-•-.- ...................... ......................... Disposal Field (Specify Requirements) .................................................•.•--.. ' •-----•----•-----••-------- ................................. ........................ r ....... .:......... ............ ... -.._....__.._.__..... (Draw existing.. and required add itian 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 District. Home owner or licen- sed agents signature certifies the following: arson €n such manner 111 certify that in the performance of the work for which this permit is issued; I shall not employ any p ! as to become subject to Workman's Compensation laws of California." Signed .. ---- ------- ----- ---------------•-•---•--- . Owner B . Titler •• 61 1 (if other than own ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _._� ... ........ ... ................. -- BUILDING PERMIT ISSUED --------•-----•--••--•-------. --- DATE _..... -• ADDITIONAL COMMENTS : ___ ..... -•---•.....- ...----•-•••• ... ........ .. ..._ :: : :::::-: :� :�: _ . , ....._. : .... Date . ......._.. Final Inspection by: s~: �� . j.. l..--- �.' .HEALTH DISTRICT 4 SAN JCIAQUI r. . _ 7/723M