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FOR OFFICE USE:.................................. 0APPLICATION FOR SAWAY14N PERMR :.................................................:.... `\2\ lCornplesin Tdplkata! Permit No. .. ......................................................... This Permit Expires 1 Year From Dob 1ss�rod Date Issued ...........Z2- f - 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. 544 and existing Rules and Regulations: c� I JOBADDRESS/LOCATION .`. /. ...._.. .... .. ...................................:...............................CEI i" TRACT .......................... Owner's Name ............ . .... - .... .....Phone .Y62— F� L... Address .. .......... ./_ .. . . j -t..... ..........'City .. -- ..I................. ..... . ... Contractor's Name �1..........................Lkense i7'1: .. ... ....... Installation will serve: Residence t�Apartmont House t] Commercial❑Traller Court i❑ Motel❑Other.................. . ..................... Number of living units:.--- - --. Number of bedrooms ..ami-......Garbage Grinder ... Lot Size .Y ._. ................. Water Supply: Public System and name ...--_... .------ ...................................._ .4e ......------.........Private❑ Character of soil to a depth of 3 feet: Sand E] Silt Q Clay j] Peat 0 Sandy Loam❑ Clay loam❑ Hardpan p Adobe❑ Fill Motorial............If yes,type............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse sick.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sower is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ] Size .............................................. Uquld Depth .................... Capacity .................... Type .................... Material.------ .............. No. Compartments ...................... Distance to nearest: Well ......... .......................Foundation ...................... Prop. Lino ...................... LEACHING LINE [ j No. of Lines _---... ................ Length of each line............................. Total Length ................ 'D' Box ............ Type Filter Material .................Depth Filter Material . ............................... ......... Distance to nearest: Well ................:....... Foundation ........................ Property Line ........................ SEEPAGE PIT [ j Depth ------------------•. Diameter ................ Number ............................ Rock Filled Yes ❑ No O WaterTable Depth ......-•........................................Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ........... ............................... Date .................................. Septic Tank (Specify Requirements) .....••-------........--..... ..............•........................................................----.--.............................. Disposal Field (Specify Requirements) ............ ..... .............................................................•--------*4:r-------7.3.. X yS-----•--0 _.. --------------------------------------------------- (Draw existing and required addition on reverse side) 1 hereby certify that 1 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 Hoeft;Dtstrkt. Home owner or licen- sed agents signature certifies the fallowing: "I certify that in the performance of the work for which osis permit Is Issued, 1. shall not employ any person in such manner as to became subject to Workman's Compensation laws of California." Signed..----------•-...----•----- -•------• •---- --•-----. .. ... -•--•-•....•.................•-- Owner By - -- ------- -• -- --- - Title ....._._s&7, (i oth han o erj E AItTM T USE ONLY APPLICATION ACCEPTED BY --- -. -- ..... __. r!._......... . . d- _✓e;:.�......................._DATE BUILDINGPERMIT ISSUED r .. . ......... ..........................................................................DATE ---- -. . ........ .. .__.... .....--- ADDITIONAL COMMENTS--- . ' .. ............................... _.._.... -------------•--. -------------. ---- ,._._._... ••---•_...I. _.__..._...............••-- -- --------- ------ -------------1----- - --------- f .... ......... Final Inspection by: ....... .... :....... ... ......... ... ...... . ............. . .. .._Date --��j - --..'--------._...._.....--- EH 13 211 1-68 Rev �....._ SAN JOAQUIN L L HEALTH DISTRICT 8/74 314