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k FOR OFFICE USE: APPLICATION' FOR �° - TION PERMIT*- � Permit (Complete in Triplicate) ---------------------------------------------------------- -9 •. _/-�- •_�_-�-"�-_ - ------------------------------------------------------- This Permit Expires 1 Year From Date Issued ..,Date Issued App, liccition-is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. ThN-appli i a in com ante County Ordinance No. 549 and existing Rules and Regulations: S JO ADDR�LO ION -- -- --------- - --------------- -------- � �ENSUS TRACT -----------------J-- Owner's Name - -- ------------------------------------------ - -------------------Phone Address —5--e-;Z- r �----------------------------- City �9 �t � ;✓ - -------•-- Contractor's Name _. _ - � ' ---- -- ------------------------License #o a_ / __ Phone C.-�-�� Installation will serve: Residence ff�Apartment House❑ Commercial ❑Trailer Court i❑ `` Motel F-1Other ---------------------------------- ------ vr+.�` I!S f jfvz az Number of living units:_---J-_--_ Number of bedrooms __�__..Garba e Grinder __ Lot Size __;:5�---- ........ Water Supply: Public System and name --- - ---- --_Private ❑ Character of soil to a depth of 3 feet: Sand Silt Q Clay ❑ Peat❑ Sandy Loam ❑ y ❑ il Fteri I _If yes;- pe Hardpan�❑" dobe'[.) Fill I M a a ty (Plot plan, showing size of lot, location of system in-1 ationYto wells, buildings, etc, must be placed on reverse side.) -NEW INSTALLATION: (No septic tank or seepage pit permitted if pu-blic sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK Size ------ Liquid Depth --- _______________ Capacity ---IS04,"ype _� ateria!_� IJ��No. Compartments -------------- Q k Distance to nearest: Well -- ----- f ------Foundation ______�-�-_-__-- Prop. Line -_:-;____-- LEACHING LINE No. of Lines ------ Z---------- Length of each line--------- ------ Total Length _._ -----_________ 'D' Box ------l... Type Filter Material __--60_ ______Depth Filter Material -_----- _____ _.__,_.. Distance to nearest: Well ---- w-----_--_ Foundation ---4----- ------------ Property Line .___ --------------- SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number -- ------------------------- Rock Filled Yes ❑ No i❑ Water Table Depth ------------------------------------------------Rock Size ----- -------------------------- Distance to nearest: Well ----------------------------------------Foundation ------.------------- Prop. Line -----------....._...__ l REPAIRJADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ----------------------------------I Septic Tank (Specify Requirements) ------------------------ - ---------•----------------- DisposalField (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- ----- --- -------------------- ------------------- ----------------------------------------------------------------------------------------------- - ------------------------------ ----- - -� •� -;r (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 Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the Following: i "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 become subject to Workman's Compensation laws of California." Signe CJ < Owner BYG->'G.-- C�fhano Title(If other FOR .DEPARTMENT US ONLY APPLICATION ACCEPTED BY ---7r, XQ--------- ----------------------- -------------------- DATE ....7-f.'_j67�--------------- BUILDING PERMIT ISSUED -------------------------------- ------------- -------DATE ------------------------- -- -------- ADDITIONAL COMMENTS ------- ---- - ----- --------------------------------------=------------------ ------------------------- 5' Routs ------ LnrtL ------------------------------------------------------- s. -------------------------------------- ------ --- --------------------- ------ ----------------------------- ---------------------------------------------------------------- 4. Final s ection by. .---------------------------------Date J � SA JOAQ IN LOCAL ACTH DISTRICT s E. H. 9 1�-'68 Rev. 5M