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FOR OFFICE USE: f - --------------• APPLICATION FOR, sA��-rAYIoN PERMITy v� .............................. Permit No. (Complete In Triplicate) ........................... Rate Issued This Permit Expires 'I 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 compliance with County Ordinance No. 549 and existi g Rules and Regulations: �� NSUS TRACT JOB ADDRESS/LO Ti N .._... .._cr . ._ a. .../V.�...5�: .. . :._._ .. /)/ `1 r� Owner's Name ...I..'/-IQ . .lam l.. ... aeT...._.. ............................Phone J.7. Address _. .../-- Contractor's .��_��. _. .............. City .........i-�..........----•--•................ _..... Contractor's Name . ---------------------------------------------------License # ..........-- ------ Phone ----.............---.......... 1 Installation will serve: Residence R Apartment House❑ Commercial❑Trailer Court i❑ Motel ❑ Other ----- -------------------------------- II// ,�r�� Number of living units:-1....... Number of bedrooms .....�--:...Garbage Grinder ............. Lot Size ..�7Xd,5.' �/---•----••••--• Water Supply: Public System and name .`Y_- -------------------• - Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe �:k Fill Material ............ If yes, type ............................ (Plot plan, showing size of lot, location of 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,} -- 6 PACKAGE TREATMENT [ SEPTIC TAN,O y Size...............................:................ liquid Depth .......................... ,1 Capacity/c - _ ciype.�........... ...... Materi I. .! o. Compartments .._ -. ..... f� Distance to nearest: Well .-- :. �1 -•rte Found tion .._ .......... Prop. Line ... .,,....... LEACHING LINE No, of Lines ______ `...........:.. Length of each JinT !-..f< �otal lengthID ...__ .-.•tic r 'D' Box .../------ Type Filter Ma r'al��._. Z---De th Filter Materia) .s� - ........ ...... Distance to nearest: Wel J ----. Foundation _. Q-- ---r----.. Property Line ---_ .'r.^............... SEEPAGE PIT Depth .. - ....... Diameter .33 .3--: Number ..5� �. Rock Filled Yes ❑ No • Water Table Depth . ................... ....Rock Size ------•---- ..................... + Distance to nearest-:'Well --------._._.• w...............:i oun at ion .................... Prop. Line ------------.._.---_-- REPAIR/ADDITION(Prev. Sanitation Permit#.------ p ----•---• Date 1 �/ fes' r Septic Tank (Specify Requirements) _ ----------------- -- ---------------•------------.......I._......_.._._-................ p (Specify q i I/Fi Disposal Field (Sped Re utremenfis} �` 1 —'� - = '...�. .. �''� `; � - t .. . n ASS/RL .� _ .................. -•••••..._...... ------ ---•-••- --------------------------------•--_...-•-------------..................................•....................................... (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 Jaws, 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 perforinanceof the work for which this permit is issued, i shall not employ any person in such manner as to becom b' t t 's Compensation laws of California." I I Sign e01 Owner Title By .......... - ---------------•--- -1 ............................................................... r (If other than owner) _ r r FOE DEPARTMENJ USE ONLY APPLICATION ACCEPTED 8Y ............ ....:_ ... DATE ._7...._..,l. :.. --�._.-_._... BUILDING PERMIT ISSUED --------- -- ------ = . ....DATE ._._..-----............_....--•••---- COMMENTS .......................................... ............. ........•--••- ........ _.._.._.._........................:................................................... ................ ------------------ --------------••• ----- •-••••-•-- ....... .__ ........._..----•••• ................................ Date e _...� Final inspection by: .. . _.. SAN JOAQUIN CAL HEALTH DISTRICT /( 7/72 3 M