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6�1 �� I� FOR OFFICE USE: 16 FOR SANITA PERMIT � i "..-... Permit No. ... 5:. .. .-. ..... - (Complete in Triplicate) !/ ..................................I——...... p ............ .... ........ .................. This Permit Expires ] Year From Date issued 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 Ordinance JNo. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION , .......-�� C�.. .-[fix.:-. !C �sE C.�l.i Y...............CENSUS TRACT ....... .......... Owner's Nome ... CYG�'..-.. ex....�1�G.......................•--.........,•-........-----:.....................Phone��`�f . a...... 8 /fro AddressAV,— .�..... .9... --. ....................... City ........1 -........... --•---............ Contractor's Name License # •-__:•_ Phone - 3.'f �. . -•• � : ..- S ------------------- ---------- Installation will serve: Residence ❑Apartment House 0 Commercial ❑Trailer Court C] 1 Motel ❑Other ............ Number of living units:.---- Number of bedrooms -_4......Gorbage Grinder .......... Lot Size ................................... .......: Water Supply: Public System and nam ........•.Private>® Character of soil to a depth of 3 feet:I Sand 10 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe 'Q Fill Material ............ If yes,type _------------_--_-------- (Plot ----------- ------------(Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet, PACKAGE TREATMENT [ ] SEPTIC TANK l ] Size...y..yT.�eq- --..... ... ....•._._..._ Liquid Depth ---•-- .......... Capacity .1 - -CJ..-•_-- Type 9.CAII. Material..C_P ecC_C-.... No. Compartments -.::z................ Distance to nearest: Well --- .A�.......------•--•••----Foundation l�_ ----------.. Prop. Line ....... i LEACHING LINE [ � No. of Lines ....../.............. Length of each line..- ......... Total Length ........... 'D' Box .-.-,1.... Type Filter Material ,&rh.......Depth Filter Material .-. 0.......................... •==-•• i I ' Property Line .��- ----_.... .. Distance to nearest: Well _...-��..--�'. Foundation - .Q..---.•.---...-- • - • - SEEPAGE PIT I 1 Depth .......; ........... Diameter ------- ........ Number ............................ Rock Filled Yes ❑ No Water Table Depth ------------•.......................... .......Rock$1ze --------...----_-_----------- Distance to nearest. Well ...................•....................Foundation .................... Prop. Line ........ ............. , REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date -.._ ............................. SepticTank (Specify Requirements, ---•....................._----_------------•---_ --------------........._................................................................ Disposal f=ield (Specify Requirements) .....................•-------••-----------.....-•-----------------.....-•-----•-------- ......... --------- ................... k-------------------------••-------•-••---- ............................. ---------•----------.........-----------•--........ ................. vii, ...... -------- -•-----------•--------..................................................................................:..................... 7` i(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: "I certify that in the performance of the work for which this permit is issued, II shall not employ any person in such mann as to become p subject to Workman's Compensation laws of California. Signed ,r.�1V.7- . . �... �rn1............. . Owner By ._. ....... --•--------------- title _... ( nor......... �.. FOR DEPARTMENT USE ONLY -------_-------_----. DATE ..-.... ---...... APPLICATION ACCEPTED i3Y .. ............................................................... ....... . . ... .............. ..•--- ................................................. BUILDINGPERMIT ISSUED ... ... ......-•...... ..............•..--.------..........DATE _.......------••----- ................. ADDITIONALCOMMENTS ................................................................................................................................................... y .............................................................................................................................................................. _ ... .. ...................................... ........... .�..-...._..........-_..... ....- ......................... ........ _ _....... ...... Final Inspection by: ......Date ._... SAN JOAQUIN LOCAL HEALTH DISTRICT ( r u 13 24 1_1s.n ca.; Kat _ _ _ 7/723-M _ �