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�.- �� FOR OFFICE USE: FOROFFICE USE: APPLICATION FOR PERMIT 0" Permit �. ;.�... (Complete in TrlplicatO 3 Date lssued..c�-`��--"= -- - This Permit Expires 1 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 compliancefwith County Ordinance No. 549 and existingeRule d Re ulafiio s: - ENSUS TRACT---------------- ---- ---- . JOB ADDRESS/LOCATION......._. Phone..:.I...... ..----------- ---- ---- --- ---- Owner's Name.... . .. . -. ---ZiP---------- I C;t 0 Address . License Contractor's Name..._. . -� - -- -- .. El Installation will serve: es'sdence ❑ Apartment House ❑ Commercial ❑ Trailer Court t - ------ --- • Motel [3 Other---- ------------ - - - - Number of living units:..... ---...Number of bedrooms..-._..Garbage Grinder-------- Lot Size- - -- ---------Private Water Supply: Public System and name.. ....................:. ) Peat C] Sandy Loam ❑ Clay Loam Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Cla ❑ Hardpan ❑ Adobe ❑ Fill Material.- .... ... If yes. type------- showing size of lot, location of (Plot plan, sh system in relation to wells, buildings, etc. must be placed on reverse side.) g � NEW INSTALLATION: (No •septic tank or seepage pit permitted if pubrlic�syewer is available within 2t}0 feet,) + x.-:-1-lL.�. ---- ----- -. Liquid Depth.,. PACKAGE TREATMENT E 1 SEPTIC TANK ( ] Size.. d -.--- _...Ma ial--- - --- -- --- - No. Compartments.-.... -. ----- . Copacity_1.-a Q TYPe----- ....... .. - ..Prop. Line..... ------ Distance to nearest: Well.:- . .....Foundation.-..._,/. j ----...---.Length of each line.------ Total Length . �.-�+ LEACHING LINE I 1 No. of Linesi .-- -� 'D' Box...... .....Type Filter Material...----..- -- ..Depth Filter Mater+a / c [�... _ Foundation----�- ----•--:----- - Distance,to nearest: Well--.--• - -PropertyIk Filled' Yes No Diameter--------------- ---Number_: ------ S �PIT [ 1 ePt --- - P ... / �cc�— - ----- - � - • Rock Size...-- � ----•--•--- tWater Table Depth ------ � -----Foundation.._.. -- ---- - - -..Prp. Line_ .-. .-- Distance to nearest: Well,_ --..- r -- -.Date.--------•------------- ) l REPAIR/ADDITION (Prev. Sanitation Permit#--.--- --•- Septic Tank (Specify Requirements)-'.- --- P . -- s1 .. ... ............: .•-•--. Disposal Field (Specify Re uirement --- ---- - --- ... .....................-------------•--- P Y q ..---•-- -- -- --- ---- ------------•-------------- + ....-.. f --------- ---- ----- '. (Draw existing and required addition an reverse side .. I hereby certify that I have prepare 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 licensed agents signature certifies the following: any person in such manner ai f 441 Y certify that in the performance �f the work for which this permit isissued, ! shall not employ to become subject to Workman's ,Corn ion laws of California." Owner F Signed.-. . - •-- -- Title._..._..... ..... .... If other than owner) FOR pARTMENT USE ONLY 03. DATE --- APPLICATION ACCEPTED BY----- DATE.._.. DIVISION OF LAND NUMBER_- -- ,............ ........ ... ... ADDITIONAL COMMENTS.... l.+th ... : �' ` r? - - - t ... ...... .... -------•- E- --------•- ------ ----•---•---- --Date. � --v 7/76 i Final lnspecr+on b ..-- -- Fas x+air Re EH 13 24 ' SAN JOAQUIN LOCAL HEALTH DISTRICT