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FOR OFFICE USF _ . L +rrAN .......:. ...... ... ......... �.. ..._.. ........... APPLICAT'IODh�R ITA N "RATION PEil�1AiY (CemplefnM Triplicates Permit o .�� ..Fe. 7`. - o-7 ......... .................... . ...:.... ......:.._.. This Permit Expires t Year From Dow bawd Date issued .. ',�'.... 2 3 Application is hereby made to the Son Jooqufn 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 Regulationsa ` . JOB ADDRESSJi.Ot/►'►IdV ._.�[-.. ..�� -�- CENSUS TRACT ............. Owner's Nome ....... r..... . ... ... ..........W- ity ._._...... Address .. .. � ..... . .� _ j .- ... .... Contractor's Name } D..��. Installation will serve: ResidencegAportment House 0 Commercial (]Trailer Court 0 Motel p Other ........................................... Number of living units:.._... Number of .......Garbage Grinder ..... Lot Size ........................................ Water Supply: Public System and name ..-:. t :. _...., / ? ...:.. ..: ...... .....•_.. .................Private Character of soil to a depth of 3 feet: Sand j] Slit❑ Clay ❑ Peat 0 Sandy Loam❑ Clay Loam[j Hardpan 0 Adobe Ek Fill Material . ......... If yes,type ... ....... .. .......... . (Plot plan, showing size of lot, location of system in relation to welts, buildings, etc. must be placed,an reverse $ide.) NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewte,r is available within 200 feet) PACKAGE TREATMENT ( ] SEPTIC TANK Size: s� _. `'. /�..- a.� . ...--..:_ Liquid Depth .., ...................� CapacityliraCl4rWT Material. yPet Compartments Distance to nearest: Weil .. . .� ...-� r r ....---.-Foundation ..lam.- ...... Prop. line .V. - O *HINGLINE ( No. of lines 07. ... _ .. Length of each line. Total Length ._ cQ r.......:. 'D' Box Type Filter Materiol ,-.....Depth Filter Material .-1 .`..`................... .,.,.. Distance to nearest: Well ,f,$" ` ........... Foundation ./V-........ . Property tine SEEPAGE PIT Depth . x,%7'7.... Diameter . ..2 .`... Number : .s7.. ............. Rack Filled Yes No C '1 Water Table Depth ........,/'3�Z5 ' ..... ...............Rock Size _.&........................ Distance to nearest: Well .. Q.. .......Foundation -AQ. .. .._. ......._. _....., Prop, Lint .%� ............ REPAIR/ADDITION(Prev. Sanitation Permit# ........ ... ............................ . Dote --------- ...................... Septic Tank (Specify Requirements) ....-._._.._....._.... .............. Disposal Field (Specify Requirements) ..........•. ------------ -- - --- ............... . ....... .. - a_ ............. ........................_. ........ ... ......, ... .... ... _ (Draw existing and required addition on reverse side} I hereby certify that I have prepared this appiliation and that the work will be done in accordance with San Joapvin County Ordinances, State Laws, and Rvles`and Regulon of the San Joaquin Local Neehh District. Herne ewow or limi- sod agents signature certifies."following: "I certify that in the performance of the work for which this permit is issued, 1 d" ow employ any person in sveh manner as to become subiect to Workman's Compensation lemrs of California.- Tilgned.:. -- _ ...... Owner -' By -.. . . . �thaiio'wned ... ....._. Title . .... ' `: Cly .(1 other J FOR`DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . ..... ..:: .... .. .: -..... :. DATE .. ..-"} ,... ,..: ......... BUILDING PERMIT ISSUED ............... .............. ................ ....__........_.......:.._..:.. ......... DATE ........_............... . ................ ADDITIONAL COMMENTS .............:.. ........:............. . ...... .. ..... ._..._ .............. :..._... ....'. ... ._:_:. .:.................... .._.. Final Irttpectfon by .i! 44R!" .. Date .1. �"y . .... ... SAN JOAQUIN LOCAL HEALTH DISTRICT E. H' "° �0 sm