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FOR OFFICE USE: <br /> .. APPLICATION:FOIA 5 NITATION PERMIT <br /> *1- -------------- {Complete in Triplicate}. - Permit No: --7 <br /> r ----- --- ------------------------------------- # - <br /> `_ # 1- Date Issued ---!�M_ 7� <br /> ------------- 7_____ This Permit Expires I Year From Date Issued { <br /> .A <br /> Applicatibrils hereby-made to-the San Joaquin Local Health District for a permit to construct and install the work herein <br /> describi d. Thais Application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> [3FLOT-r�) RD <br /> JOB ADDRESS/LOCATION57QF.af".F, 9�!: � NUS TRACT ---fs -- <br /> Owner's Name` --------------------------------------------------------- '-------------.Phone ----------------------=------------- <br /> AddressaoeP__.fie------------------------------------ -------------City _ -Q<,&7Z>s1-=-----------------------------------------._--.------- <br /> Contractor's Name __. a;&27 e d -- License # 17g�3----- Phone <br /> tnstallation will'serve: tom_ Residence 0 Apartment House f]Commercial ❑Trailer Court ',❑ <br /> Motel ❑ Other ---------------------=---------------------- <br /> Number of living units:_-_�______ Number of bedrooms --------Garbage Grinder /yU__ _ Lot Size _AW__1.Y_X5_0----------------------- <br /> Water Supply: Public System and name - - - -------------------------•-------------------------------------------------------------- --•-- - -__Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam=❑ <br /> Hardpan Adobe' Fill Material __________ If es, <br /> p ❑ ❑ Y type ---------------------------- <br /> N.. <br /> ----- - -- - ---- - <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 1� <br /> NEW INSTALLATION: (No septic tank or'seepage pit permitted-if'public sewer is available within 200 feet,) a <br /> 4 PACKAGE TREATMENT,,I.) SEPTIC TANK ii - -------------I_ r�"____________I-_.______ Liquid Depth �________________ <br /> V <br /> k Capacity Type �LVMf __ Material�,�_Q_ _ No. Compartments a _________________ r <br /> Distance to nearest: Well :----_t--------'__ ` <br /> --------------Foundation /a ----------- Prop. Line ._�'.__....__.._._._ <br /> LEACHING LINE No. of Lines P .I ; <br /> d�] Length iof'each line______� '--------- ---- Total Length -17Q-..___....._------ <br /> 'D' Box . ____ Type Filter Material��C/-______-Depth Filter'Material ............. <br /> ' Distance to nearest: Well __y_--_________ Foundation ----L_c1__'__-.____ Property line __,6____________________ <br /> Sgg%G&FIT.,.,� Depth -------------------- Diameter ________ _______ Number _____ .-------- --------- Rock Filled Yes No <br /> Water Table Depth - - ------- ff/'---_- _Rock Size --------------------- <br /> —,f Distance to nearest- Well ----&a---------------------------Foundation _1�-------_.---- Prop. Line ----_�- -----.--.- <br /> p�m t <br /> REPAIR/ADDITION{Prev. Sanitation Permit#`-•--°--------------------------------- Date 1___________--`--------------__-__) <br /> Septic Tank (Specify Requirements) --------------------------------------------------------------- 4 <br /> Disposal Field (Specify Requirements) ----- <br /> -. ------------------ ) t -------------------- <br /> - <br /> ----- - ---,---- , - - - . ---- <br /> -: <br /> ��•_e,__._ ____ ___ - "-y--" ��'1_'_'______•__'�.,�+`-+'r`r4_4� <br /> (Draw existing and required addition ori reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> l "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to becom/subj n's Compensation laws of California." <br /> Signed ---- - - - - ------------------------------------- --- Owner <br /> BY ----------- -- --- ---- ----- Title ------------------ <br /> (If oer) <br /> FOR,.DEPAitTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - [ `� -------------------------------------------------------------------------- DATE ----/ `_f-- -- -------------- <br /> BUILDING PERMIT ISSUED -~ r ------- - _ -DATE ------------ <br />: ADDITIONAL COMMENTS <br /> ) • --------- Alf �._ ��' <br /> -- ------------------RE -------------------------------------------------- - -------- <br /> --- --- -- -- <br /> ---------------- <br /> ff <br /> Final Insp bY- --- ---- ----- ------------------- l <br />: x- ------Date ---~ ----------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICTR` ` <br /> E. H. 9 1-'68 Rev. SM <br />