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FOR OFFICE USE: APPLICATION FOR SA TAT[ON PERMIT° Permit No:7e � �E,i (Complete,in Triplicate) --______ Date issued >� -70 This Permit Expires 3 Year From Date Issued --- -- e work pp A lication is hereby madeto the S in complianceJoaquin Local Health District i tOrd Ordinance ermit to c and exist ng Rules onstruct and tand hRegulat ons: ' described. This applicationd �J&� ' CENSUS TRACT .d— JOB ADDRESS/LOCATION Phone Owner's Name ---- - ,yam • - City . f v Address - --._ v�t``�'--f------ ----------------------------------- --------------- ----._ Fs'fLicense# 1i � Phone „ �`s�r �•- a � .�• - ----- / Contractor's Name .____ ' Installation will serve: Residence A Apartment House�❑ Commercial ❑Trailer Court i❑ Motel ❑ Other "------------------------------------------- � 4�_ Lot Size ,��-�� •----.... .__ Garbage Grinder/" --- - Number of living units: _ =---- Number of bedrooms .__ _ , g . may, �/ �--�-- --------•--------------------Private E]Water Supply: Public System and name ----��. �/-r� �' - - Character of soil to a depth of 3 feet: Sand'(] Silt❑ Clay Peat [I Sandy Loam ❑ Clay Loam .D9 Hardpan ❑ Adobe)4 Fill Material ------------ If yes,type ----------------------------buildings, etc. must be placed on reverse side.] l� 4i (Plot pian, showing size of lot, location of system in relation to walls, 0 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 260 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK'[ ] Size----------------------------------- ---- - - Liquid Depth -------------------------- . Compartments --..----•---• -__ No. Capacity -- - -------------- Type -------------------- Material-------- ----- Foundation -------- ------------- Prop. Line ----------=-• Distance to nearest: Well --------------------- - - LEACHING,LINE [ ] No. of Lines ----------- - --------- Length of each line-__---------------- ------ Total Length ----------- ---------------- _De Depth Filter Material ---------------•---•------- 'D' Box ----- ------ Type Filter Material _____________"----- P Distance to nearest: Well ------------------------------- Foundation ------------------------ Property Line ----------------_----- 3 Rock f-i{led Yes No 0 I SEEPAGE PIT [ ] Depth _ --_- --- Diameter ---------------- Number -------------------- ❑ ----------- WaterTable Depth ----------------•---------- ......-•------------Rock Size --------------------------------- - � --------- ---------- Pro Lina ------------------- r - . --4T_ - -------•------_Foundation p. • Distance to neares#: We _____"_________________•- ,. i -------------- REPAI /ADDITION(Prev. Sanitationerm� -------------------------------------------- } Date Septic Tank (Specify Requirements) ----------------f-•-------- v _ p !o-------- �f "l Disposal Field (Specify Requirements) __- , = ------ . . - 't /� -e----------- t' r ------------------ -------------- -- } (Draw existing and required addition 'onreverse side) I hereby certify that.1have.prepared.,#his,application and that the work will be done in accordance with San Joaquin of the San Joaquin Local Health District. Home owner or licen- County Ordinances, State Laws, and Rules and Regulations sed agents signature certifies the following"': "I certify that in the performance of the work for which this permit is issued, ( shall not employ nny person in such manner as to become subject toiWorkman's Comp ion-'laws-of-California.", 4 Owner i9 -------•----- I t ;i " r --./fir . Title_•, ---- ,_.. - , 6 --------------------- '(If er than owner) I R DEPARTMENT USE ONLY ' ------------ ------------- - DATE ga�7 APPLICATION ACCEPTED.BY -- = �, w s =DATE t.,'_... BUILDING PERMIT ISSUED _________________________ -______.--- ----------- -- ----- ------- - ! ADDITIONAL COMMENTS `t -------`------- = W ----------------------------- ----------- -------- =" ------ f _ 4-Y _ ___ -.- a?-___________________-__Y-.___-____.___-_________ --_._._--- -------- � ---- - - - - = -- ---- ------- ------------------- ---------- ----- to -- - --- -- - - ----- { Final Inspection Y- -------------=----- ----------- - - ------------------•----- ,�. --------------------- j SAN J AQUIN LOCAL HEALTH DISTRICT, , 1-'6$ Rev. 5M