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i - F,'CUR OFFICE USE. TM'.:-. APPLIC _ PERMIT S� _ �..-. .. .. ----- ..................r_......,.._........ ` Permit No. ---------�- w (Complete iq=Triplicate) - ----- jl ...----- ..... ................... ..............:...: This Permit ExpirP.s l ee ' Date Issued . ... .......... Date Issued .._r�.'.............. Application is hereby, made to,the Son Joaquin Local Health .District for a permit to construct and install the work herein wi - described. This application is made in com lBonce t unty .Qidinonce No, 549 and existing Mules and Regulations: Owner s Name � �-'�'--- �,..... . .....�--- --- - AVI G.: _ /---_---_----.........CENSUS TRACT -•------------------------ JOB ADDRESS/LOCATION ..•.: .0_ '®�1 �e.0�/ oe!5............ ... ��// ........................................... ............Phone .................................... Address ..... �� F►'� .-I!FA, rr '44;................................................ City. ' -----..-_-----•----.. ........................... Contractor's Name .� � .. P ------------------•----------------....license # `f a ��.. Phone P� 4�...... Installation will serve: Residence R<Portment House�❑ Commercial ["]Trailer Court ❑ Motel d Other --------------------------------- Number of living units:......... Number of bedrooms .-. ....Garbage Grinder / �'... Lot Size 0X -low---------------------- Water Supply: Public System and name .... - � .� ..............................':.Private C]Character of soil to a depth of 3 feet: Sand El Silt C] Clay F) Peat.❑ Sandy Loom El Clay Loam t Hardpan ❑ Adobe Fill Material ............ If yes, type ........................ --.-• (Plot pian, showing-size-of lot,--location of systerri'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,) ! PACKAGE TREATMENT SEPTIC TANK Vd Size... _. -Irf �..... ......... .... Liquid Depth Capacity /2P0------- Type/4�/,�O/.. MaterialNo. Compartments 02o--................ c Distance to nearest: Well . =r�77 --------- - - /. --------Foundation . e/ � 0.----.--__-:_ Prop. Line ,��---.......... S LEACHING LINELen Length No. of Lines of each line. ` # /' ._ g `��....:. ........ Total Length ��r�-----------= •--_- 'D' Box 41e. . Type Filter Material/ie 4A(41 Depth Filter Material 4?!�------------------------_- ------ i Distance to nearest: Well ...*— ....�....+._.... Foundation ./�'�.- Property Line ��.-.------_----.- SEEPAGE PIT ;A Depth .Orv. .-.-.-. Diameter _t.?------- Number .../......,f...._... Rock Filled Yes,& No 447- m Water Table Depth o��-^�.---------•---•------•••--......Rock Size/�.-_X. ...---- ------ r i f Distance to nearest: Well ..-------"?-......................Foundation .../Q... ..._... Prop. Line ...,_............. € REPAIR/ADDITION(Pre _ . _ y Sianit+ation... .Permit -------- Date ----------------------) SepticTank (SpeMy Requirements)' ,._ ........................ _...•----------------•-------------- ....... ` .........--------..-..-----. --------••-• ` Disposal Field (Specify Requirements) ------------------ -------•--------- ---------.....-- .......... ..._..... ----------..... ---•----• ------------ ..- ........-- ... ..... '-" (Drdw 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 Couaty Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Nome 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 shall .not leniploy any person in such manner as to become subject to Workman's Compensation laws of California." i Signed . Owner L.A``.�. ..... ............ __ .... er than owner) R ' -----FOR—DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY .. ` l ...------. .............. i.. DATE ... :. -. ...._ BUILDING PERMIT ISSUED _..- -.-.... ........... .. ?...DATE ........................................... i ADDITIONAL COMMENTS , ;E . .............. .............. :_. --•---.-.... ------------- --- ;r+'=- ....... ........ ...................................................... Final inspection by _..� ............,�...............................bate .....................:. l.Cs........ SANE JOAQ LOCAL HEALTH DISTRICT / // E. H. 13 24 I_'68 Rev- 5M 7/723 K