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FOR OFFICE USE: APPI,ICAT1.0it tail; SANITATION PERMIT it .� ` (Complete in Triplicate) PermNo. ...... ........... � Date Issued •7-/7 This Permit Expires 1 Year from Date Issued ........... Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 'I JOB ADDRESS/LOCAT N. _...( .• t...�s.�cre G��-� � CENSUS TRACT ........................... Owner's Name . .._.lc�.� 1 .a�.....................................................:................Phone ..........._....--•--- ........ _ v Address ................ VJ �- f... ._...1. .e................... city . ........................................................ a Contractor's Name ...... .....License 59t _Phone .............................. i installation will serve: Residence partrr ent House 0 Commercial OTraller Court ] Motel Q Other Number of living units:... ...... Number of bedrooms .::.:..::._Garbage Grinder ........... Lot Size ..........................................:: Water Supply: Public Systein and name . :..:..:... " f�`:...................w. ......................Private Character of soil to a depth of 3 feet: Sand n Slit❑-, Clay M!feat Q Sandy Loam {� Clay loam Q Hardpan ❑ Adobe 0 Fill Materlal ............ if yes,type............... ............ (Piot 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 permittee[ if public sewer is available within 200 feet,} PACKAGE TREATMENT [ SEPTIC TANK ] Size..................... . Liquid Depth Capacity .................... Type ------••.......--... Material..........'... _ ......No. Compartments o - LEACH Distance to nearest: Well ....................................Foundation ...................... Prop. Line . ING LINE---[-J—No: of lines ........................ Length of each line............................. Total Length ............................ 'D' Box ............ Type Filter Material ....._.._:.. ..Depth .Filter Material Distance to nearest, Well ........................ Foundation .........:.............. Property tine ........................ SEEPAGE PIT [ ; Depth .................... Diameter ................ .Number ............................ Rock Filled Yes Q No (:1 Water Table Depth Rock Size Distance to nearest: Well ........................................foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prey. Sanitation. Permit . Date ....... ............ Septic Tank (Specify Requirements). ...:................ .. .. . .. Disposal Field (Specify Requirements) �-ccs►;-..... ....... .G � ..... - P �X1�._X --------------------------------.............................. ..........................................................:..................................................... .... {Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be don* in accordance with Scan Joaquin County Ordinances, State Laws, and Rules and (Regulations of the San Joaquin Local Health:District. Home owner or liven- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit Is Issued, 1 shall not employ any penton In such manner as to become jest to W man's Compen tion ws of California." Si ned 'g -- ----- -- ----- - -- �{.. �------------ Owner By ..... --•• -•-------•------- -----------•.:._......._.. Title .... _.... Of other than owner] FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY -.... BUILDINGPERMIT ISSUED ........-.....................................................--------------------------------------------DATE ...-....................................... . ADDITIONAL COMMENTS ---------------•. ..............------..... ---------- .............................._....-----------------......... ........................ ....• --._... -•---•. ..... ^�- Final Inspection by: _... ----•-•--- - ...—.......................• ------------------ ..........Date ... ....... rJ'... ... ....... EH 13 2L 1-6 i SAKI JOAQUIN LOCAL HEALTH DISTRICT 874 3M t