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FOR OFFICE USE: APPLICATION FOR` SAID trATION PERMIT (Complete in Triplicate) Permit No. ...73.'..�. .. ............. _��...: This Permit Expires 1 Year From Date Issued Date Issued _. Application is hereby ade to thp San Joaquin Local Health District for a permit to construct and install the work herein described. This ypli n is de in compliance with County Ordinance No. 549 and existing Rules and Regulations: .i08 AUDRES5/L CATION .:.. rcQ s�.::._1- -,. .�SJT.,-- _ s..__.•.............. ..............CE:NSUS TRACT ...............:.. .::.... Owner's Name .._.., ./�Z_........ ✓l..r✓CJ 'L.. ............................. ............ ..................Phone -----......................:........ i Address !�'��_. ._�!�'1.�.....�------------- ........... Cit ..._............._........ ......................... Contractor's Name 0'f ........._- ...........__._..Liicense # 7/-�. �f'..... Phone Installation will serve: Residence partment Housed Commercial OTraller Court a Motel [3 Other -------------------------------------------- Number of living units-------- __ Number of bedrooms _2.......Garbage Grinder _ Lot Size ................. Water Supply: Public System and name .......................................................:.......................................................Private Character of soil to a depth of 3 feet; Sand n Silt❑ Clay 0 Peat 0 Sandy Loam [3 Clay Loam Hardpan ❑ Adobe iii Material'.... if yes,type ............................ (Plot plan, showing size of lot, location ofd system in relation to wells, buildings, etc. 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 _[ } SEPTIC TANK Size...�r�a�.I ............. .......... Liquid Depth 1.12 ---_-_---- t ' /ao4 n No. Compartments Capacity TYPeC .. Material.__.. ..._..- P .. Distance to nearest: Well ......P..........................Foundation ............... Prop. Line ....... LEACHING LENS [ o. of Lines ...x�4.............. Length of earn line---11'- .._rfi-r.�...--- Total Length J_�....�.........-._. O e� gg77 r z Type Filter Material _-_ . . .Depth Filter Materia! ,�Q...._._.___. 'D' Box .fr,�/ ,�5� - --•-• - - ,. �-v ..... ..................... ¢ Distance to nearest: Well ....�a��..f_........ Foundation ..�._.�--_-----_-_--Property Line TS�...I............. A , SEEPAGE PIT [Ij�Depth r�_.__...._ Diameter .3�?01 ._.:, Number ..._. r __.__._.._..`Rock Filled Yes �No [] Water Table Depth _---__--- r� f -•----....Rock Size ./�:.?�:3.:.....:....... Foundation -." Distance to nearest: Well --•- - ...... - Prop. Line ... REPAIR/ADDITION(Prev. Sanitation Permit# ...........................:.•-•-=----...... Dote ....J.....____.--.------._...-•--) SepticTank (Specify Requirements) .........................•-••-••------• ••------------•------•-•...--••----.....--•----•---•-•••••-•--..........---• -•-•-•••-----•---- DisposalField (Specify Requirements) ---------------------------•---- ---------------------------- .................................................................. ._..4 _ _______________________ _______________________________________________________________________-....___._-_............._...____........._.._____._._.._........._....____...........___...... r (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 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." kSigned ................... - ............. Owner Y -•-- .................. .. .....-_ . ........:................ Title ..... !l.�L .............. ' (Ifo than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .- _-._ --- .. ..... DATE .._.�.. ....... .'�3_._.'.......... i BUILDING PERMIT ISSUED .... .... . .... .......... .................:..............DATE._.:::.............__-_..............._..... I flAL COMMENT _.:.." ................•----------................. ---- . ....0 •----• -r-•---...........�....---•-•-----•--..:..- = = -------------- . ---- -------•----...----..._.__...-•••---•-•-- -•-_.. -•-•.... ....... �} Da Final Inspection by: ............. C . .. ------•--=---------- • .•. ........... to ... .��. r SAN JOAQUIN LOCAL_ HEALTH DISTRICT / c u 13 24 1_-An o__ qAA 7172 3 M