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FOR OFFICE USE: APPLICATION FOIA..SAWITAT1ON PERMIT ick/ Permit No. _2 -----------------------------•-- --------- -- ------" (Complete in Triplicate) --------------------- --------------- Date Issued This Permit Expires 1 Year From Date Issue Local Health District for a permit to=.,construct;andnS'install th Application is hereby made to the San Joaquin Re ulat ons e'n Loc described. This application is made in compliance with County Ordinance No 549�and existing_ , 5 g JOB ADDRESS/LOCATION / ---- --`` V ----- CENSUS TRACT Owner's Name Address __._____ } -� -------V)_i-/ i, f14 : Phone f-`��=f ------- ------ V_ vY - [ City ----��SC--r------------ �� -----------------` ------------------License # ------------------------ Phone --------------------------- ContractarWill serve.. Resid t installationence Apartment House'Q Commercial :❑Trailer Court iQ � Motel ❑Other _ --- ---------- Number of living units:------�----- Number of bedrooms _�---.==Garbage Grinder-- ;.��_ Lot Size,_�__ i ------ Priv ate• ;�y - -- --------------- Water Supply: Public System and,-name --- --------- ---------- -------------- -------- -------- ---- : . --��. Pea )V--- pp ��``�� Loa Cl y Loa Character ofs'oil fio'a depth of 3 feet: Sand Q -_ AdQ �..CIpFiIIQMafierial d_�!/al f Yes, type --- a m .p ~- Hardpan T-- �i I [Plot plan, showing size of lot, location ,oeem in ,relation to wells, buildings,;etc. must be placed on reverse side.] f.,syst ' NEW INSTALLATION: (No septic tank.,or seepage pit permitted if publicr sewer is available within 200 feet,) Size .f , Liquid-Depth -------------------------- ; PACKAGE TREATMENT- [ ]- SEPTIC TANK'[ 1 "Material'.-------------- � � ---- ---------- o. Compartments -----------•------•---,�. Capac�tY --------------------- Yp s-•- -- C �-Foundation_-�'- -------------- Total - --- ---- Prop. Line - Distance to nearest: Well --- ---------------------- -------- _ - - Total Length --------- --- LEACHING LINE [ } No, of Lines -------- - ength of each line--------------------- = k ;�----- ---- =. 00 l i 'D' Bok ----- _. Type Filter terial --------------------- -------------- --------------- -- Depth Filter 'N4 erial _ Property Line ---------- ------------- Distopce to nearest: Well _____ __�_____________ Foundation p ty No i❑ SEEPAGE PIT [ ] Depth --- Diamete ---------------- Number ------------------------ Rock Filled Yes ❑ . ----------------- Water Table Depth ___1-----------..' - -----------------------------Rock Size ---------- -- - ------ G Distance.to nearest: Well -.____ _ _____________________ Foundation -- - --------- Prop. Line --------------------•- ) REPAIR/ADDITION(Prev. Sanitation Permit# --------------- --------------- ------------ Date --- .- {.+, Septic Tank (Specify Requirements) ----------------------------------------------------------- ..-- -- >FH: hl hD 7T/e r - - ------ Disposal Field (Specify Requirements) ___--, ,7• ; l x�'si`r- = -----------------------= r = _ j i ----ex------ and required addition ori°reverse w ----------------- -------------------------=- ' '------ ,� {Draw g q 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: II "1 certi tha n� he pert r 'ante of the work for which this permit is issued, i shaft not employ any person in such manner as to b e subject to rkman's Compensation laws of California." SignedL,47 --- Owner �. -'--- ---- - ------ ----------- ------------ ------�--r - -- --} ----- title ----------- --- - -------------- --- y __________ ___ __ f other than owner) -FOR DEPARTMENT "USE ..ONLY- DATE; DATE --� `f ------ APPLICATION ACCEPTED BY.:=------- y --------------- ---..� _. _._ . -- - : — _ _.DATE: -=-_.:---------- -------- -_=---= ------- BUILDING PERMIT ISSUED--,------- - ..`__-__-------`-_`--------------------------------------- --------- --- ------------------------------------------------ ADDITIONAL COMMENTS __.. ------------------ - ---- -- - ---------- " ------------------------------- -----------. - f ------- ------- ------------------------ -------�-.Date _ -------- - Final Inspe =----------- ---------- - SAN JOAQUIN LOCAL 'HEALTH DISTRICT r u 0 1.'f,R RPv SM -