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FSOR OFFiICE USE: .x y APPLICATION FOR SAN1TAYiCiIt6 PEKING}T _ .........:..:.. _... ............._._...._..... . ..... . Permit No. .._._......-----•-• ... ..,.. {Complete in Triplicate) _._...._.4....... ............ ........................ Date Issued .�/_7— -2 ............................I._... This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District. for a .permit to construct and install the work herein described. This application is made.in.•compllance with County Ord trance No. 549 and existing,Rules and Regulations- -------.__.. ._ _ . ._.::...:CEN t15 TRACT JOB ADDRESS/LOCATIONC:�• " ' �/ ` hone ...... Owners Name Gl ..._.. ii- ............ = P ... Address : _._...z .............. .... •--•••---•••........................... City .....-- •-----.........----........._....._.4........._... � Contractor's Name _..._.... ....................License #�� 1./-�_..:_. Phone...��-f � Installation will serve: Kesidence ❑Apartment House Commercial railer Court 0 1 Motel ❑Other .................... .......I....... Number of living units:------------ Number of bedroom .Garbage Grinder .._.__w_..._ Lot'Size• .. -.- .. ---- ........... Water Supply: Public System and name ..... '.. . `.. .. _.__... .. ..... ........... Private ❑ , Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam El Clay Loam Hardpan ❑] Adobe'D Fill Material :----------- If yes,type._...------------------------ (Plot plan, showing size of lot, location of. system in relation to:well ; buildings, etc. must be placed on reverse side_.} sewer is available within 2d0 feet,} V;' NEW INSTALLATION: (No septic tank or seepage pit permitted if-public ` rt t PACKAGE TREATMENT [ ] SEPTIC TANK Size._.'. . . A.�..t�............. Liquid Depth . .._._ ' k. ........ -02 No. Compartments .. . Material_- T It Capacity � �'�.. 1��._ Type .,.k........... {� •-- Distance to nearest: Well -__-_-_---- Foundation ... Prop. Line ____,........... LEACHING LINE [ ] No. 'of Lines _.__. ................ Length of each line...._(.V__.-:......... Total Length .............. i 'D' Box ------------ Type Filter Material ....................Depth Filter Material __.1- -•------- ......_..- .......... i Foundation Property Line Distance to nearest: Well ----""-'............... Rock Filled.-Yes,3,••�••No ❑ SEEPAGE PIT { ] Depth --- ... Diameter .__.�f_.1�•-•--•-- Number -----...---•- • ... __. Water Table Depth •••-•-•--•---•............ .. Rock Size ..... .. .............. . Distance to nearest: Well ..Foundation .................... Prop. Line .....:..___..__.---_.- REPAIR/ADDITION(Prev. Sanitation Permit 5rk` -------•.. ............•------..__......---- Date .................................. - Tank(Specify-Requirements) - --......... . .........----••. —-------------- Septic Disposal Field (Specify Requirerr+ents) - .....----•.................. ................:............................. -- �...�--`. - ------•-----•... ............. --._-.--------------•--•--- r •--------•--... -•----------------•----•----...._ r-._.�....:._ ,.7.._._..- (Draw existing and required addition on reverse side) Joaquin I hereby certify that I have1prepared this application and that the work will be done in accordance with San or Ilcew County Ordinances, State taws, 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 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ..__ .-- --- ---- ..:............ Owner j . ... .... .......7 . ......... ........................ -------- . Title ..... (If of er than owners P RTMENT USE ONLY APPLICATION ACCEPTED BY ------ DATE _.��L3•- -.-_--•---._•.•: _.._ . BUILDING PERMIT ISSUED DATE :.._-..:. ::..... l ADDITIONAL COMMENTS ."" __....../... ::.._. ...._:- ................-- ' .............................................. . .........__..-••---....---.._..----_. .. ..... .. ......................•-••-... ,.----- - . •- . . --... --- --------------- ...................................................... DateZY Final Inspection by: ....: .. ..... .. =. ..� . SA JOAQUIN LOCAL HEALTH DISTRICT I �- 13 24, CAA 7/72 3 PI