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FOR OFFICE USE: t� APPLICATIOWFOR'UNITATION PERMIT --_ _ ` ----- (Complete in Triplicate) ? A J --- - ---- ---- ---- ---------- ... i Date issued ---------------------------------------------------------- This Permit Expires 1 Year From Date Issue ------------------ � • ,, it to construc an Application is hereby e work herein made to the San Joaquin om dance witfh Couealth ntytOrd;nan a Nom549 and existing Rules tand thRegulat ons: described. This application is made p I . « � CENSUS TRACT --------------•------ JOB ADDRESS/LOCATION ` _ ' �""� =-------------- -- a �j v P ne Owner's Name `_# r .. ' '��SG�Cf`, ��----------------------------------•-•-•--•- Address - *—C-AMM t_�= City pho t _ -. /f---- ne/J-r.r_ fEC/ ntractor's Name -P, t 1 -- -r License # i �,� ( fes Co t _ ... Installation will serve: } Res;dence�Apartment House'❑ Commercial :❑Trailer Court $ t ' Motel [I Other -------------------------------------------- ► kLot Size l�_ - 2. -------•--•- Garbage Grinder r , Number of}living units-------------- Number of bedrooms - __4_._:_ -- - Private ❑ " k = _r_� ----- ------------------------- -- Water Supply: Public System and name ------------- � I # 'Clay Peat. Sandy Loam ❑ Clay Loam ;❑ Character,,of soil to a depth of 3 feet: Sand❑ Silt❑ Cla ❑ ❑ Fill Material ------------ If yes,type -------------------- � E �—•e ' � Hardpan E] Adobe: - k {Piot plan, showing ,size of lot, location of system in relation to eEls, buildings, etc. must be.placed on reverse side.) -1i \ NEW INSTALLATION; (No septic tank or seepage pit permitted if. public sewer is available within 200 feet,] ` SEPTIC TANK [.� w _, . _ - # -------------- --- Liquid Depth tr Size------------------ - PACKAGE TREATMENT�"[ No, Compartments l CapacityType -------------------- Material_----------------- t ------ --•----- ------ Distance to nearest: Well ------------------------------------Foundation ---------------------- Prop. Line -------.-------,--- I ------------ ------ Total Length 4-------------•------•------ LEACHING LINE [ I No. of Lines Length of each line______ -- , ---------------- ---- -- { Depth Filter Material ----------- --------•--•-------------I------ 'D' Box ------------ Type Filter Material --------•--- p I Property Line --- Foundation ------------------------ p iy ------------------------ Diameter ------•--------- -•- -• Distance to nearest: Well ---------------------i ---- Number --- ------------------------ Rock Filled Yes C3 No 0 l SEEPAGE PIT [ ] Depth _ Diamefier ___________- - ---------------- --- S! --------Rock Size -------------- ------ Water Table Depth ------------------------- I ------•----------Foundation ---------------•---- Prop. Line ---------------•------ Distance to nearest: Well ____------------------ - ------ -- Date ---------------------------•------) REPAIR/ADbITION(Prev. Sanitation Permit --------- ------ - ------------- - Septic Tank (Specify Requirements) --- ---------------------- --- ------------------------- ---------------- - t+ 1 Disposal Field (Specify Requirements) ------` 0----- ------------------- - -------------------- -------------------------------------------- --------------------------------------------------------- (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 r 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- forarson in such manner "I certify that in the performance of the work which this permit is issued, I shall not employ any p j as to bec�-su lett to Workman's Compensation laws of California." Owner Signed --- -------------- Title ---- -------- --- --- - {1f other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE -- BUILDING PERMIT ISSUED ---------------- ---------------- ADDITIONAL COMMENTS - �L �� -----jr ------------------------------------------ ------------------------------------------------------------------------- ------------------------------------------------------------------------------ --- - - ----- - O ------------- - Date SAN Final Inspection b QUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M