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FOR OFFICE OSE: >-, -- APPLICATION FOR SAIWTATION PERMIT -- -- --- `�------ ---- --- --------- P � Permit No: ._71-/a_�l (Complewn Triplicate) ----------.`a" ' �. This Permit Expires i Year From bate Issued Date Issued - --- -- -------------- ---- Application is hereby made to the San Joaquin Local Health District for a perm it to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: J . JOB"ADDRESS/LOC TION ._.f.-- -lK�--_1-------- -----_'-- z�►'!- Gill-----CENSUS TRACT -------- �'C a; c o� ,Q_ S r�=S , _�_ rIZ-�--------------- ---------- -- �__X-3 A `Y Owner's Name _ _ ^ _Phone . t Address ,�'74a . City `�� --- ------------------------------ --------------- _ 3 Contractor's Name ----------------------------------------------------------------------------------------License # ------- ----------------- Phone --------------------!......--- Installation will serve: Residence ❑ Apartment House,❑ Commercia []Trailer Court '0 j Motel E-] Other Number of living units:_._ ------ Number of bedrooms ---------Garbage Grinder _ Lot Size .. Water Supply: Public System and name ------------------ --------------- ------- ------ -------------------------------------------------------------------Private - - - Character of soil to a depth of 3 feet: Sand-E] Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ---------------------------- (Plot , ___________________________(Plot,plan, showing size of lot, iocatiori 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,) i y PACKAGE TREATMENT { ] SEP TAN ""Size---- --,X--k .- _ _______ Liquid Depth CcipC(c y Z_Q__,-- Type��`�_S. of MaterialjCa _� __`" No. Compartments ---�C.----!--•----- Distance!-to nearest: Well __` f ��_ __________________FoundatiorL__.�_ __--_----___ Prop. Line - _#_______. LEACHING LINEA Nq; of Lines -- ________________ Length of each line 7�( ____.___..____ Total Length __ ..'........ D- Box Type Filter Materiat9 epth Filter Material _/ -----r • gr Distance to nearest: Well ________________________ Foundation ----___ ---------------- Property Line, ---------------:__._.___ SEEPAGE PIT '.[ ] Depth- -------------------- Diameter ---------------- Number --------------------------- Rock Filled Yes ❑ No C] Water Table Depth . - T ----- -- Rock Size `` 3 r fD,istance to nearest: Well ---------- _ �' _.'. -__?_,__._Foundation ______`A_ -- -- Prop. Line_____________'________ 1 .. 1 ` REPAIR/ADDITION(Prev.,Sanitation Permit# --------t_----------------- Date =:-__-------� -- :. .ES,6ptic Tank (Spe`ci�f'y gquirements) --------------------- - ------------------ IT 1F i R� r Disposal Field (Specify-Requirements) -------------------------------1---.------ ---- ---------------p-------------------------------------------------------------------- 27 --------- r � ---------------------- . 27-_x_ `��n/K- 4Ct� °= - = k ( ------------ — (Draw existing-and requite", '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'Iicon- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become lett to Work a ' o pensatii.o lawsfof California." Signe e�------ --------------------------- Owner BY ----------------------- --------------------------------- ------------ --------- Title -------- --------------------------------------------------------------- (If other than owner) ) tFOR DEPARTMENT USE jONLY ,c APPLICATION ACCEPTED BY _-- _-- i !__ _- ----a___.-_----. DATE -- - ---T---•------ -r7 ---- k= _ r' BUILDING PERMIT ISSUED DATE - '. ADDITIONAL COMMENTS -------- ------------ -------------------------------------------- --------------------------------------------------------••---------------- �_ - ------------------------------------ - ------------- -� ________ ______________ _________ ___ __ _____ ___Y_________f _ __ - _ -____--____- ________..---------------------------------------- -------- __. _ .____._.____________.__.. Final Inspection -------------------------------.Date ...... P SAN JOAQUIN LOCAL HEALTH DISTRICT � E. H.J9� ' 1-'68',Rev. SM �. � � ��'� •.,_.``_,�. `: -y.- -� �'S��n �- -�. _.,..�• - - - - �- �L -