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FOR OFFICE USE: APPLICATION OR SANITATION PERMIT _ • �.N l Permit No. ..�1..5..-31•••_. ;. """ " (Complete in Triplicate) ............-........I.................... , Date Issued ...1-..... ... ... ..........• ( This Permit Expires 1 Year From Dale I$sued l the work Application is hereby made to the Sin compliance with Health -DistrictCountlnance No 549 and existing Rulesfor a permit to construct and talnd Regulotlonstein ; described. This application is made p ��v ..................... . ...... ....... ..........CENSUS TRACT .t. JOB ADDRESS/LOCAT{O k %.o- .c{-a _ .. .. .. . . ..... .. .. ...... ..... .Phone........................ Owner's Name ._' -... City •-•........................................ . ..... 52 :3 Address ...... • � � . . � # rfFv�� Lam.... Phone .............................. • # f License Contractor's Name ... -a Installation will serve: Residence(Apartment House❑ Commerclol pTrailer Court Motel 0 Other ............. Number of living vnitsi..)....... Number of bedrooms ......Garbage Grinder ... Lot Size _...... • .......................Private ................... Water Supply: Public System and name ............................... ...... Pegt[J Sondy loam [B,` Clay Loam Q Character of soil to a depth of 3 feet Sand El Silt C1 Cloy ❑ , % Hardpan❑ Adobe 0 Fill Material ............If yes,type ' (Plot plan, showing size of lot, location of. system--in-relation-td wells, buildings, etc. must be placed on reverse side.) i# permitted if public sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or see ge p p , Liquid Depth ..4............... SEPTIC TANK PACKAGE TREATMENT [ J - j No. Compartments ---••-••-••-- i .� .,_Mcteriai.... % Capacity -�. Q. ...__. Type ....... .......-- ,,rG % Foundation ....1._1..... Prop. Line "5 - G Distance to nearest: Well ..........^ (� No. of Lines - Length of each line. .4-�� •• p Total Length _•.. t.EACHING LINE J..q.'............._.__............... � .....:.Depth Filter Material ... � D' Box 1...... Type Filter.Material Line •- ' . ndotian ...�.�'..'............. Property -.._�-... Distance to nearest: Well ...._... ;tv........... Fou ............�.............. Rock [ Depth ..�.P' Dietn+eter '...�».' tyumber ,, tiled Yes o o Rock Size ./ ,,�...... '�F , o • --pt line .---. --•-------- Water Table Depth --- ...._. .... ................. - i � ...... ...... l Distance to nearest: Well •.......•-•--•-•-•••• .......Foundation p• Sanitation Permit# .----••-••••................ .... Data .................) REPAIR/ADDITION(Prev. ; r .......................... Septic Tank (Specify Requirements? ..•-••-•••••••- t •-•••............................................................. ci Requirements) .......................••••-• E Disposal Field (specify q '•••""""""" .......................... ......_... ...................:........._........ ............... ............................ (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 t County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District.Home owner or lisett- sed agents signature certifies the following: di steal) not employ any person in such manner f "I certify that in the performance of the work for which this permit is issue , as to become subject to Workman's Compensation laws of California." U, .' ............... Owner r v Signed ................. .. _............ t'..,_�-, ` '1 ``. .......•.... Title .. /!' .............................. /""'�` By (If other than owner) FOR DEPARTMENT USE ONLY ` ./y ,?�,, DATE ........................................... APPLICATION ACCEPTED BY .. ............. . ...........::........................... ................ DATE BUILDING PERMIT ISSUED .................:...................:.................._............._....-•..... ADDITIONALCOMMENTS....................•..........•.......•---._.................._.......:......................... ..... ................. .................... .................. �.... .......2e........................... ........ -••.........................._Date . . =.,1 .......... ...... Final Inspection by; - r ! .......................................................... SAN JOAQUIN •LOCAL• HEALTH DISTRICT -- - _7/723M „_.. e,a