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„,FOR OFFICE DISE: �'-aAI� CATION FORNITATION PERMIT P ”SA �_j 7 .� - Permit No. :..:........::.:.....::.. ICompleteln.Tripticatel ..__ - . 5-'' \ Date Issued ......................................................... This Permit Expires I Year From Date Issued , Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein l described. This application is made in complian with Co ty Ordinance Na- 54 and exWR10es gulations: Ll JOB ADDRESS/LOCATIONOwner's Name ...Address ............•--.--_. , ---_..--------... -- . .�............................... -••--......-- --- ........... .:city ................ IContractor's Name ---- ---- --- -- --- -- - (J - • _ -- _ License _ Phone Installation will serve: Residence Q Apartment House[] Commercial f7railer Court 0 ` Motel ❑Other.......-•--- .... Number of living units------------- Number,o€ bedrooms ---....Garbage Grinder .::.. Lbat Size ----- ------------ Water Supply:I • Public System and name {...-- --• ... .---Private . Character of soil to a depth of feet:� San _ P d S1 ❑ Clay ❑ feat❑ Sandy Loam ]. CiaY,Loam.-0 Hardpan Q Adobe Q Fill Material ........._If yes,type (Plot plan, showing size of got, location of system in relation to wells, buildings, etc. must be placed on reverse side.) OQ NEW ENS ALIAYION: ` r.. _ (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} CN PACKAGE TREATMENT f 3 'SEPTIC TANK ] Siae._ ly x �� r .. ...�. .____._. Liquid .......... ... Depth .1�.� Capacity © e Material-.---- _ l "`_Typ ------• No. Compartmenii,, ... . -" Distance to`nearest: Well j ............. Foundat:on . � ... .. Pro . Line .._._., ... :." LEACHING LINE { ] No. of Lines . z -_-- Length of each line...t-0-__ T� .. 9otal• b6i t .�. I ; . .......... °Type .Pilfer Material ..__/ DeFilter Material ..... _._ �. Distance to nearest:`Well ...�.�.- ,�D .. S Foundaho -. - ------ Property Line ...r.... ......... Depth _�:p�y '�.iracnetier .......... On ................... hock Filled Yes No �] V' Water Table,?bspth -- ........ &-• --- ......... ......hock Size ,./. ..� �r 60 Distance to nearest. Well ......./Tv....................-FoundationPr.-- ! - _ op. Line ......Jf REPAIR/ADDITION(Prev. Sanitation Permit�#i.._._.-.-_-..-_-•- ._�. pate "* .. ---- ..._ Septic Tank {Specify Requirements# _.._--_: l................. ..:. •............................. ..•........::......_: Disposal Field (Specify Requirements) ... ................... i ----------------------------------- hereby certify that ! have prepare(DrawAh Is applicationanand '..........addition a side)" ,.. r .. existing q red addition on reverse side)�- 4 �1 that the work will be done in accordance with San Joaquin -County Ordinances, State Laws, and Mules cind Regulations of the Son Joaquin Local Health:District. Horne owner or licen- sed agents signature certifies th�Vollowing: "I certify.that in the performance of the work for which this permit is,issued, l shall not employ any person in such manner as to become subject to Workman's Com cation laws of.California." Signed -. ---• 4 ner I ---------------- BY .._... -- --- -- ..(, .. . . itle --- --------------- { other t an erJ � - OR DEPARTM NT USE ONLY APPLICATION ACCEPTED BY . DATE BUILDING PERMIT ISSUED ... .___.__._ = `� ... , .................... DATE =- -------- A DITIONAL OMMENTS --------------------• -• - --- L -- •-• -- ....................... ........__.. ...... , y ---------- ----------- a. �z 1 ._. .. .. -`, �-. } - 1 _,_\moi i final Inspection. --- _ ---•-----�---•..-----•--�"--------- ----- Date -..-:.��"^ ..''�:::._...-..-- EH 13 24 1-b{3 di v. 5mi � ... �. SA AQLiIN LOCAL HEALTH DISTRICT 8/7h 3M