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FOR OFFICE USE: -1 APPLICATION FOR SAN A'P14N PERMIT (Complete In Triplicate) Permit No, -3 ............ .. ...... ...... This Permit Expires 1 Year Erato Date Issued Date !sued«.....3.7`� Application is hereby made to the San Joaquin total Health District for a permit to construct and Install the work herein described. This application Is .made 1n-.co`mpiian a with County,.Ordinance No. 549 and existing Rules and Regulations: JOB ADDRE /LOCATI O SS f CENSUS TRACT Owner's Name �J-� }, ?�- �� .kl. Address =C_ o (_ e- -_ Contract r' - �- .................._._.. .... ....._.. - -------- o s Name - �--- ""�- . ._ ---- --- --- •---•�'~.-. ..3��..... Phone -C�..��...._7.. Installation will serve: Residence Apartment House C) Commercial oTrailer Court ] Motel p Other 3 .,%,A . I Number of living { . (� units_____________ Number of bedrooms .. _.__...__Garbage4,:Gdnder L l /` # Y e.....- Water Supply: Public System and name i 1 ~' � •• -- _ -••••••••- -- Character of soil to a depth of 3 fee`#:. Sand❑ Silt o Cloy 1 _`` Y 9© Peat❑ Sandy Loam 0 Clay Loam Q `.Ward an � � "--•- "'. p ❑ Adobe Fiji-Material'. ...... if yes,.type....:.... .... .... (Piot plan, showing size of lot�•'i c tion of system in relation"i.o ells;buildings-wo , etc, must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if p b t sewer.is avai able within feet,) j PACKAGE TREATMENT [ I SEPTIC TANK{ I size............ N,11 .......� __.....• Liquid Depth ................... Capacity e •---------- TYP -• Material:.. No. Compartments I T ---------- ....----=•... ! � 11 Distance to nearest: Well •---•••••••- • LEACHING LINE I g ' Foundation .._ Prop. Line -� Length of each '11' ................... . ..•- j j No. of Lines _....._if yp - Tota! Length '©' Bax ..........1, T e Filter Material ._.Depth !.Filter Material Distance to nearest: Well __________________ Foundation ... . r t ........:..:.... Property Line .......................Ic SEEPAGE PIT [ } Dept _ ..:'.._ _..._... Diameter -•_-•. "--....._ I�tumber _.._..__ t�_ ' . 1 -------------•..Rock Filled Yes Q N IV o Water Table Depth _...--=_: -:! a - ---_RocNoteion iz :. ' Distance to nearest: Well �. ..............�•-•J-•---• -_. Pra Line� ._..Fou .----•-•--...._-- REPAIR/ADDITION(Prev. Sanitation Permit# . -__ Date --------------- .-_._ Septic Tank (Specify Requirements} � Disposal Field (Specify R equirem intsl ________________ --------- --------------------------- ---- — -�— ----------- --- (Draw 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 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.Dlstrict. Horne 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 Colifornla, Signed ------ ------•-.._._.._ BY ---- --- -- • ...__. t .... Title i (if other t owner) ----------- ------ DEP TMENT USE ONLY APPLICATION ACCEPTED BY _.-. _ ._- BUILDING PERMIT ISSUED -------- -------•---------- ---------------------•------- DATE . -017)�'- ADDITION L�OMMEN S -------- - --------------------------•----------•---------- ----- DATE - 1.. ..............................•--- DA _ .. - ,, -•-------•----- Final Inspection by: . ----------- ---------"-•"-- ........:...-----------------------------Date . !Ir EH 13 .24 1-68 Rev. 5m y" �� SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M i I