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'FO-P10FFICE USE: UN[UtION PERMIT APPLICATION FOR S -------------------------------------------------------- Permit No. (Completerin TritTicate) --------- -- -------------------------------------------- ----------------------------------------- --------------- This Permit Exp.ires I. Year From Date Issbed Date Issued Application is hereby made J uin Local Healtk District'for ia permit` to-construct and install the work herein described. This application is m in mp iance with unty Ordinai4ce No. 549 dfi.d ex t, Rules and Regulations: e t, Tp J, u 5? ting'n ;D� m JOB ADDRESS L TIO -- -- ----------- --C��2 -CENSUS TRACT -------------- ----------- Owner's Name -7/_^,.001X_a------ZZ// c:_41i Phone ------------------------------------ -- -------- - Address ------ - -- ------ ---- City ---------------------------------------------- --------------�-- --./- ------- C -Z I ame .-' - -6 ----_. ,?,9 ----------------------i------ -.License #/ -5� Contractor's §,� -Phon- -------------------- --------------------- Installation will serve: Residence 916-0`rtment House-E] Commercial []Trailer I Court ',F] Motel F-1 Other ---------------------------------------- f +,. I Number of living units:-------- Number clrooms_,.�L__._=Garbage Grinder Lot Size _,/X ------------------- ----------------Private 1-1 Water Supply: Public System and name --- -- --- - ------- -7---------------------------- '_�F�-i Clay Loam E] Character of soil to a depth o�3 feet: Sand'El Si 0 Clay J2--- Peat 0 Sandy Loam Hardpa"n EJ Adobe'914'i'll MclterialA)4-�)__ If yes, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to- welis,'buildings, etc. must} be placed on reverse side.) c sewer is available i a NEW INSTALLATION.- JNo septic tank or seepage pit permitted if public ble within 200 feet,) PACKAGE TREATMENT SEPTIC TANK -�ize__ Liquid Depth -----�/_X?__ _-- -115---_7�-------------- M.t-erial(--i2-�,_:��-�'N.o:�"Compartments ------------_-- .... Na Dist ce to nearest: Well ------------—-------------_-----Fourid-11-on ....' ----- Prop. Line . ..... Lj� LEACHING LINE No. of Lines ---- —------------ Length of each --- Total Length ./ZD D' Box Type Filter Material -C. ept ---------------- ----- ------- ---- --- e� MaterialI -- ------- --- ------------- ' - -------------------- D h Filter Distance to nearest: Well ------------------------ Foundation 19 -------- Property Line ,SEEPAGE PIT [VDepth Diameter __,E-�-ANumb'er ------ - ---------------- Rock Filled Yes U3--N-60 Water Table Depth -------- ------------------- ..-..Rock ize ---- --- ---- ---- Distance to nearest: Well ----------=7=n7== ------ ..Found dti op,-'-52- ------ Prop. Line __S................ REPAIR/ADDITION(Prev. Sanitation Permit=# ----------------- ------------------------ -'Date ....... -------------- Septic Tank (Specify Requirements) --------------------------------------------- -----------I --------------------------------------------------------------------- Disposal Field (Specify Requirements) ------------------------------- -------------------- - ---------------------------------------------------------- ----------- ------------ --------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------- (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 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: "I certify that in the performance of the work for which this permit is Issued, I sh%ll not employ any person in such manner as to become subject to Workman's Compensation laws of California.,'� Signed --- ------------------------- ----------------------------------------- Owner - ----- -(7��--------------- Title -----7_)6,J, ----------------------------------------------------------- By ----------------------------------- ---Lo (If other tha wn FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By --- -_� 41 V� _ _ _n ------------------ ----- ------------------------------------------------------------------------------ DATE --- 71 - l -1 BUILDING PERMIT ISSUED ---- ----- ----- ------------------------------------------------- --- ------------------- --- - -----DATE ------------------------------ - ADDITIONAL COMMENTS ---------------------------------------------------------------------------- I - ---------- ----------------------------- ------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- --- -------------------------------------------------- -------------------------------------------e)------------------------------------------------------------------------------------i------------------------------------------------------------------------ --------------------------------- ------- Final Inspection by. _WV%-JA_.�--------------------------------------------------Al----- ----------------------------- -Date -------------------------- ------ ------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M