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?. _. . .. . FOR OFFICE 4lSE: :.� APPLICATION FOR S"wwrm PERMIT ....,. ................................................... ICompiete in Triplicate) Permit No. .A- .. . This Permit Expires ! Your From Date Issued _ Date issued Application is hereby made to the San Joaquin local Health District for 1' APp y q permit to construct and instal! the work herein described. This.application Is made In compliance with County Ordinance No. 544 and existing Rules and Regulatlonsi /...... .......... ......... JOB ADDRESS/LOCATION ../.��...0� 7 � /�fY?�? ` ....ZA-2s,,,.�C.,CENSUS TRACT ..^��..........: Owner's Name .......S.� C�P.. ...... .�.'. a.G�a�. .,................. ...................................Phone, .... z/.. Address ....:....... r>.,? .-.��cir1_�. ................ ---.•-• ......._....City ..��__�............................................................. Contractor's Name ..--__G x .. �a�.__I r,�c :.,fes � am se #,J.ZZ.�� . Phone .............................. will serve: Reside WApartment House C] Comm Ial❑Trailer Court ❑ Motel❑Other............................................ Number of living units:---. ..... Number of bedrooms .6......Garbage Grinder .------- -- Lot SizeWater Supply.Supply: Public System and name •..................•_..........._r_..__••..__.........._-......_.......,.__._........-------------•••--.....Privats�. Character of soli to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat 0 Sandy Loam ❑ Clay Loam Hardpan)d Adobe❑ Fill Materlal ............ If yes,type ............... :........... (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 isablle ,) .-. e within'200 feet PACKAGE TREATMENT I ] SEPTIC TANK f ) S#ze. X.1..�. i. ._ .f.!9��.P..�. Llquld Depth ........................... Capacity .................... Type .................... No. Compartments ..�:.....,....6 0 �.�,00./ llz Distance to nearest: Well ....................................Foundation ...................... Prop. Line ---------------..------J LEACHING LINE [ ) No. of Lin es ......1............... Length,of each line. ........... Total Longo) . /J.................... r 1 (tS{ c ru S�s/e"- -D- Box I------- Type Filter Material/ Depth Filter Moierial ..f�.:�.. ........................ • 10 Distance to nearest, Well .._.57 f....... Foundatlow. /4Q...2.... Property Line ............. . { [ Depth ../0.....`..... Moms#er yX2----_. Number .....:7.................. Rock Fille Yes a( No ❑3 a Water Table Depth Ir—. rl c r � p .....••---......_..©---••-!.__........-•---.Rock Size,�..1............ ..... . o Distance to nearest: Wel! v�? ....Z`' ....:.... Foundation -./49..`7...... prop. Line _,,.a.., ........... 1b REPAIR/ADDITION(Prev. Sanitation Permit# ......... ........"...... Date ..................................) Septic Tank )Specify Requirements) ............. .................. .---......I............................ ,........._......... ...... � Dis osal Field !Specify Requirements) .. ... � ----_••_-..•-,•.............,.1..._.............._..--•-•---•----••--•--..,_..__......... : ._..........•................ ..........� .-•----. . •--••---............ 3 _ ..... ............................. '{ 44 1 •--•-• �• (Draw existing and requlred-additi non reverse side) f�1 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 )icon- sed agents signature certifies the following: € "i certify that in th rformance of the work whir s'permit is issued, 1 sfiail not employ any person In such manner as to be ome sub orkman' mpen t on !a of California" , ti Signed -....... g ---------------- _.. Owner By .......................................................... ..... _._...---------•--•-•-• -•----•--•-- Title ------- .. Of other than owner) FOR ARTMENT USE ONLY , APPLICATION ACCEPTED BY ...._.... ....... DATE ...... BUILDING PERMIT ISSUED .DATE ADDITIONAL COMMENTS . .........................................` ' ..................................................................... ti--.. ..`...---.... }..s"........ ......................_. �...... .................................................. ..................................... _._..-----.------.._....... -......... .............................._..._........................................... ..... ....._........ .................................. ........... .--- �: Final Inspection by f� `...._.. ..... ... ... ..... .. ..................Date .z.. �y7..............._... EH 13 24 1-60 Ra'. - ` SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3H M1