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F4?R Qr*E'USE: APPLICATIO �ION PERMIT - �jG� Permit No. ..__�/Ofd// �� (CIC o let m T i Iicate) O7 Wmit ire F Date Issued Date Issued --------------------- p ------------ --------------- Application is hereby made t San Joaquin Local Health District for a permit to construct and install the work herein described. This application is de in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION . __ _________,___ ________ALR Q __ _ '_T_-'___ WAX TRACT ___��_��p�_____ Owner's Name _______-__�N -----------/__O__Z�4_N_�-__-_ Phone__!__�rL'_®_--7.2:–__ Address ------------1 ��------------ -5=---- ----------------- City -2-6-51?-1-7-----------4ATN_�Qr------------------ p Contractor's Name hlo-g-'_1 ___/af}�K � -___-59EfN)C a_____-License # __ -_,_______-_____ Phone k-52=1/C70__ Installation will serve: Residence gj] partment House❑ Commercial ❑Trailer Court ;❑ Motel ❑Other ------------------------------------------- Number of livingunits:_____ ______ Number of bedrooms _ Garba e Grindery_t—C_ Lot Size ___�-�©® 8____�'_____- ----• g / Water Supply: Public System and name ----------------------•------------------------------------------------•---------------------------->----------Private Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ PeatSandy Loam Clay Loam;❑ Hardpan E] Adobe ❑ Fill Material _ Q--- 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,) �` PACKAGE TREATMENT [ ] SEPTIC TANK [a;}� Size__�X.f0__X-----5�__---------- Liquid Depth _____7-lr_______ Capacity _f 2_ 2 --- Typepw�� __ Material e�J_N_PtT__ No. Compartments -----2 1 ...... c -4-. stance to nearest: Well ---__-_4_-_------- ------------Foundation __ 0.7t7--_-_Prop. Line ------5--,------_ 70 , LEACHING LINE [ No. of Lines ------ _____________ Length of each line_____ _____________________ Total Length _____.%2�-------------- 'D' �_________ 'D' Box/Xi 5 Type-FNter Material ��___Depth Filter,Materiai ______49___ ________________t____ _ Distance to nearest: Well __ __" __ _ Foundation ___lV__"---___ Property Line ___J.___.-'f'.___ SEEPAGE PIT----[-] Depth ----------------_-Diameter --------------- Number ---------------------------- Rock Filled Yes [j 110 [�'� WaterTable Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well --------------------------------------- Foundation ------------ ------- Prop. Line _-____-_______---__-_ REPAIR/ADDITION(Prev. Sanitation Permit# --------------- ---------------------------- Date ________________________________) SepticTank (Specify Requirements) --------'------------------------------------------------------------•------- ----------------------.-------------------------- DisposalField (Specify Requirements) ---------->------------------------------------------------------------------------------------------------------------------------ �nr .�Q mo-----------?_t1_v ---- /__�------ n1Et�-liV G----------------------------------------------------- A ------------------------- ------------------ --------------------------------------------------------------I------------------------------------------------------------ -------------------------------- (Draw existing and required addition on reverse side) I 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 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 be4 ahfest to Work 's Compen tion laws of California." Signed �'� '! -I------- -------- ----------------------------------- Owner BY -------------------------------------------------------------- ---------------------------------------- Title ---------------------------------------- ---------- --------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------Ti-r1-`®1----------------------------------------------------------------------- DATE ------ 71-------- BUILDING PERMIT ISSUED ________________ --------------------DATE -------------________________ ADDITIONALCOMMENTS ------------ ----------------------------------------------------------------------------------------------- --------------------=--------------------------- --- -- - --- - - -- - -- -- - --- ---- - - - ------- ---- --- -- -- ------ - Final Inspectio - - Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M