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FOR OFFICE USE..- APPL:ICAtI $AM 'i4T1dN PERMIT . ., k: e l � DN .hOR °.'ICompfete in Triplicate) ....... .: Permit No.�� ....... ............................................ ''" "This.PorrnnitExpire t Year From Datelsaued Application is herebymade to the San Joaquin Local Health .District for a.-permit'to construct and 'Install the work herein ' described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: } .. JOB ADDRESS/LOCATION ._..' incl. ...........•.......CENSUS TRACT ... r Owner's Name .. .�.0 Vic. .� L�►� t' t .............. # Address .. :.� 3 ' _ so_......nl:.__ l Q d Contractor's Name I i. g r # :_t�'1.- •• ---.license # --------• ------• ----- Phone __._.._..... Installation will serve: Residence Apartment House ] Commercial oTroiler Court 0 s . � --c P .. Mate! �Other.u_ m_ .cel _ :Number of living units:----�___--- Number of bedrooms .a...._ Garb go Grinder ---------:-- Lot Size __..�C,-t`t_s . c ........... 5"_ 5"Water SuPPIY= Public System and name -------------•- ----------- -- : �. . Private Character of soil to a depth of 3 feet; Sand 0 Silt 0 Clay 0 Peat Q Sandy loam ❑ Clay Loam Hardpan❑ AdobeD Fill Material __ If yes,type.....:......... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.j 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 l ) SEPTIC TANK[ ] f Size................ �) Liquid Depth ...:�,6A.2T:..... JZ Capacity p ty -- 0O_----.. Type - t Material'_. nl , -f,—No. Compartments _s................ Distance to nearest: Well, .... o------------------••----.Foundation _h_a--------- Prop. Line �.t--- LEACHING LINE ] No. of Lines _.__ ,C'� .� -------"-, - Length of each line....... Total Length �.7b.. ?:___..... 'D' Box ...X..... Type Filter Material L � �Li;ckpePth Filter Material Distance to nearest: WellQ. .. �•),,, ------------- Foundation 1a.;t:-........... Property Line .:}3.°i... /.•b.: SEEPAGE PIT [ l Depth �� f 'r .................... Diameter ,_..3.._3.•._.. Number _..02 ............ Rock Filled Yes No Water Table Depth ....... ------------_----- ", a 117-- « . • Rock $EYe _: ��. _. Distance to nearest: Well �' Foundation .:ja_t___ prop, Line .f .-_- _._._ REPAIR/ADDITION(Prev. Sanitation Permits4'•` ........ •----...._.. ........ Date ,.---' :.f._. Septic Tank (Specify Requirementsl ............... ...... A .............•.......-•.�_..•....r....•.........• f ............................ Disposal Field (Specify Requirements! ............... il. -------------• --------- ----------•--------------------... -------- .-•-------- L - _ ------------- ----- -------- ----------------------- _------- -------------••----------•------ (Draw existing and requiredaddition ori teverse side) I hereby certify that I have prepared this application and that the work will be donee In accordance with .San Joaquin County Ordinances, State Laliivs, and Rules and Regulations of the Sun Joaquin local Health District. Home owner or ficin• sed agents signature certiflesthe following: "I certify that in the perfo rnr ance of: the work for which s witimi_is-Issued, I shall not employ as to become subject Wor ai►'s Compensation ig of California." p y any parson In such manner Signed } - =��- Owner # BY ----- -------- --------------------------------- "-.. _ f ------ xitle .............. •..... _�. ... (If other Baan �S�irner) ----•• ........................--•------------..... FOR EPARTM NT USE ONLY t � APPLICATION ACCEPTED BY___-- . _ BUILDING PERMIT ISSU>r©- ._-._._... .. -3....--• DATE 1�/�Z - ---------- ----•------ •------------------------ ...DATE _..._.-...----------..._ ADDITIONAL COMMENTS ............ -- ------ ...------- 3 " ^}}} --------- .. ........................................................... _.. .......... _._...._....._.__.. h ......................................... ... .. final Inspection b ........ .. ........."_..__._._........_..---...------- _ _ _ . y° ---.__.. ...Date . . .. - EH 13 24 r 1=5 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M.