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......................... .......... Date lsssl7 c..................... This Permit Expires l Year From Date Issued t a � Application is hereby made to.the San Joaquin Local Health District for a permif'to construct and��'reailPthe work herein described. This application is made in compliance with Countybrdinance No, 549 and existing,Rules an � egulations: JOB ADDRESS/LOCATION... --...CENSUS TRACT.- ..-------- ' Owner's Name._ --- -------- .--- Phone- ---- --•--------- ---- ... Address.... - ......Ci ......---- -- ._-Zip.................. '� l Contractor's Name---- ............ icense # 1 ..-•..Phone...�..: F� ----- Installation will serve: Residence ] Apo rtm ------ Hou e ❑ ommercial ❑ rat r Court ❑ ' motel O Number of living units:---.../-------:Number of ear m's_i -_Gar, .ge•Grinder: Lot-Size:=-Size'-4747 ; ..�- �'�-- -- ...--<--- ---- - ' Water Supply: Public System and namle---.... ---. <-- -- Private ❑ Character of soil:to a depth of 3 feet: ❑ Silt ❑ Play ❑ P •❑ Sandy Loom ❑ Clay LoarrJ,l Hardpan ❑ 3 Fill; vaterial-- --.......it es, ype-------------------------..-- - (Plot plan, showing size of lot, I do of s tern tele ation to wells, uildings, et must be�plciced"on reverse side.) f NEW INSTALLATION: No se sink or e ppit permit d publit sewer is available within 200 feet,] Qom. PACKAGE TREATMENT SE C NIC [ 5' 1-1'"'X""�----A-J-0--- -- q p `j # t C acity- ..-- Type.. Ma ial.-_ No. Compartments..... .. ----- --� . t f �) Pro Line., !stance o eare : [I__.. _. .....Foundation.-./ . . ...-.. .. :.Prop,LEACHING L[NE j ] of'.Li es _ ....-- . g .. - .i. '. .... __.. i.... Length of each line -. Total Len th :.... D' Type Filter Material_,. Dept Filter Material Distant t nearest: Well. Foundation-------_------------------Property Line -....---.----,--------.......------. SEEPAGE PIT [ ] Depth.:- I) / Rock Filled Ye No ❑• _..Diameter Number f,. i Wate Table Depth._. .. .... ------------ --------Rock Size...... _...-- - -------..------- . Dis ' nce to nearest: Well---- '�j= ----.Foundation............- Prop. Line.- ,... � ` REPAIR/ADDITION (Prev. anitotion Permit#-- ---------------------- ` ...........bate............. .................. ----------- Septic -----=--Septic Tank (Specify Re irements)----------- --------------- ------ ---------•-- .............. -------------------- ...... ........... Disposal Field (Specif Requirements).......f�.----------- -------•- - ----------- -- --- ------------------- -- `------•---•--- 1 ------------- ---....- ............... ............. t t < , ......... -- ---------------------------�-- ---- F iDraw.Aexisting and required addition on reverse side) )"r 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 licensed agents signature certifies the following:+ "I certify that ,in the performance aftthe 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."� y Signed.-- - --- Owner„By. i _ ------ ---------------- . - ..Title----- ---- ------------- ------------ :. ..... iI th r-t n ner 1 1i FOR. DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..-- -- .. -----DATE ........ �.0 �'.�- . . .. DIVISION OF LAND NUMBERQ_>_ ---- DATE. ADDITIONAL COMMENTS............... .... ... ----------- 1 ,. i :: - .... - ..--. - - a-. .. i; . - -----._.. _ _ .......... Final Inspection b ` i Date_....---. : y:.: F&5 21677 REV. 7/76 3M EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT E