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FOR-OFFICE USE: APPLICATION FOR SAWATION PERMIT � �,!_ y�1/ Permit No. -../� •----•-• / (comp)eve in Triplicate) .. .. ••-••-- ............................. bate Issued -•3-d_•7 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 compliance with County Ordinance No. 549 and existing Rules and Regulations: ......CE ....... CENSUS TRACT ............. JOB ADDRESS/LOCATION .._.... r..................V., :. 1 s - .....:........... . Phone ... Owner's Name ............. Address ......._. -_.. ............... ..---- ............... City ......... i �.�.................... ...-...l.......- a , .. _ = S ` .. ..... Phone..../. .C .licensa # Contractors Name Installation will serve: Residence Apartment House fl Commercial❑Trailer Court ❑ Motel ❑Other ...-•--••-•••••.............. ........---•-•• '- � Garbo a Grinder 7 .. Lot Size .1.�?._.....X...................... Number of livingunits:.... Number of bedrooms `� 9 ....�... .. Public System and name .........................................................._...._....._...................._._.........._......Private Water Supply- Character of sail to a depth of 3 feet: Sand❑ Slit 0 Clay ❑ Peat❑ Sandy Loam 0 Clay loam 0 f Hardpan❑ Adobe Fill Material ............ If yes,type ............... ............ (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.)�A N9W INSTALLATIONS INo septic tank or seepage pit permitted if public sewer is available within 240 feet,) PACKAGE TREATMENT I ] SEPTIC TANK i ] Sixe.................... ..._---.-.-------- Liquid. Depth ................... Capacity .................... Type ..................... Material.............:.. No. Compartments .................... Distance.to nearest: Well .......-Foundation....................... Prop. Line ...I................. . Length of each line--------- 3-••••••.-• Total Length ....... ....... LEACHING LINE �(J No. of Lines ......-- �. .... Len g 'D' Box .. Type Fitter Material :.. -Depth .Filter Material .......... ................. .T� .� Yp .... G—X/S7/N Cj f�'__...--- Foundation ..._ ., }..._.... Property Line ..... --...... Distance to nearest; Well .._...s: - . .............I....._- Rock filled Yes W No SEEPAGE PIT �Q Depth .... :.2_.... _ Diameter ... _.�._.. Number -I- f}-:DZ) 7-z- Water Table Depth . ?---.............-........Rock Size ...... -2 ............... i Distance to nearest: Well _tPP ' - ..............Foundation .. Prop. Line ...... .............. REPAIR/ADDITION(Prev. Sanitation Permit Septic Tank S eci ....--•--......-•--•-•.......................•----•-- ......................................... j p fY Re quirements) Disposal Field (Specify Requirements) ------- --------------------------------------------------- ..................... ------------•----•-------••----------- ---------------------------........._............................................-_......-•....................................... jDrow existing and required addition on reverse sidel ! 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.Distrlct. Home owner Or, )lath ' sed agents signature certifies the following: arson in such manner "I certify that in the performance of the work for which this permit is issued, I shnil not employ any p as to become subject o Workman's Compensat':on laws of California-" Signed ..... ...........--...•---- .,r..!--------- Owner By •--- ------------ A ..... .... Title _....... ...................... ...... ... ' Of other than owner) F DOARTMEWT USE ONLY APPLICATION ACCEPTED BY _.J ...,._- ' -_ �y =_ - DATE .. ..�.- -- - BUILDING PERMIT ISSUED ----- .-.._ - ...... ... ................... ............ ... ADDITIONAL COMMENTS ._ riler.. ,�yd?.�e.�.:.-.. /` ----------------------------------- ............................ } --•--...--•---------------------- -------------------------------------------------------------- ---------------------------------- . - ..---------...__..........._......___._ ......... ....................... .. . Final Inspection b .......................... ............ Date .................. ...................... a ' Eli 13 2h 1-68 Rev. 5)'1 SAN JOAQUIN LOCAL HEALTH DISTINCT 8/7h 3M 1