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FOR OFFICE USE: APPLICATION FCkxS%NIT-ATION PERMIT ��,f�' Permit No_•:-Ox:(D/ ---- - - ---- --------- ---- -------------------- ` - - {Complefie in �: 3licatel } ----� ---- ._ ------------------- This - -------- ------ Date Issued ------�- This Permit Expires 1 Year From Date issued 1 rict for a ermit to construct and in dAppi�ctat'46n is escribe1,Thishappl cationeisomade in compliance with County the Son Joai� Local Health tOrdinan a No. 549 a d ex st g RulestalndthRegula#ons: rein ,r,rGrG ._._ e_c4_ ..-CENSUS TRACT 5-`'�1--------- JOS ADDRESS/LOCATIO 06. Wtu.5- � � �` Owner's Name _�[h,.�yri_t�s- ---- - -P•Gc.�----� _�`'-- �i----- ------------•------ Phone /� Cit G3.r ---------------------------- ----------------•-•- Address --------- • L- SL:ba' ''------------------------------- Y Contractor's Name ____67714 ----- -----------------------------------License # -------------------------- Phone -- ---------------- Installation will serve: Residence ❑ Apartment House Commercial ❑Trailer Court l❑ =4 Mote! ❑ Other,_,5_AA6A jS+a^r----------- Number of living units_____________ Number of bedrooms ___________Garbage Grinder ------------ Lot Size -------------------------------------------- - _____________ ________ _____ ---- ____Private ❑ Water Supply: Public System and name Character of soil to a depth of 3 feet: Sand Si it❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay'Loam ❑ Hardpan ❑ Adobe•❑ Fill Material -------It---- if yes, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.);_. . tt� NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availabie within 200 feet,) g. d. PACKAGE TREATMENT SEPTIC TANKSize-------- ----------- ---------- --------- -- - Liquid Depth --------------------------- Capacity _.------- -------- -------------------- ----Ca acit -- Type -------------------- Material---------------------- No. Compartments -----------------_---- `? -----------Foundation ---------------------- Prop. Line •-----•----------- --- ; r� Distance to nearest: Well ----------------------- Len th of each line---------------------------- Tota! Length ---------------------------- ------------ 'D' ------------------------•-- '�.. LEACHING LINE [ ] No. of Lines g Depth Filter Materia! -------------------------------- Distance ----------------- ------------ ' -----.__---yp - ------------ ------- Pro a LEne . -----------------=---- Foundation .__ P rtY Distan a to nearest: Well Material p SEEPAGE PIT [ ] . Depth Diameter --- Number ---------------------------- Rock Filled Yes ❑ No 0 WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well -------------------------------------- Foundation -------------------- Prop. Line ---------------------- Imo, REPAIR./ADDITION(Prev. Sanitation Permit# --------------------------------------------- Date ----------------------------------) Septic Tank (Specify Requirements) --------- -------------------- ----------- - I Disposal Field [Specify Requirements).,-�Pi& � �-x�O-N-'S.f-O-N---.--- ---------�',"�-r,.�-----p�-�i.r�.��___=-�'�c,..�'m_e,_�r_�`f�g 1��_� - -St�..L_v�r_-�_}.:f�__!��_ .�r�l- if ------------------------------------ ' t (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 District. Home owner or licen- sed agents signature certifies the following: - 1 shall not employ any person in such manner "I certify that in the performance of the work for which this permit is,issued, as to become subject to Workman's Compensation laws of California. Signed ------- ____:__ Owner ; _. — � BY ------ ---------(i -------than -owner) �.. (if other than owner) FOR DEPARTMENT USE ONLY IP �� -6- ------------ APPLICATION ACCEPTED BY ----- --------- ---- ------------------------- DATE 7-------- BUILDINGPERMIT ISSUED ------------------------------------------ ------------------------------------------------=--- --------- DATE - - ADDITIONAL COMMENTS -------------------- ----------------------------------- ---------------------- ------------------ `--- -------- ------------------------------------------------___________________________________________________________________________________________________________________ _________ i, ____ _ _________ _ Date ------------------------------------------------- ------------- Final Ins ection b SAN JOAQUIN LOCAL HEALTH DISTRICT I E. H. 9 1-'668 Rbv�l5M. '