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-°-FOR OFFICE USE: APPLICATION FOR T 1 N PERMIT .................:................................ •----- Y ....................................•-----------------. (Complete inrp tea } Permit No. _.7 _.� �� --....................................................... This Permit Expires I Year From Date Issued Date Issued . i 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ...57/j�Q.. '1�'ke!�4 ._..LZ..........._..................... ................CENSUS TRACT 445 Owner's Name .644.,K7.---- -Xf S -O.."............................................................................Phone .................... i Address ... .._.5.7hP-. .GJ.t./.:"v_' /J--_..................................City .........47.OC(i..-.......................1-,"14--on Contractor's Name ......... .... ..........License #•30s`!�!........ Phone .3'1p�:31�3-5'• f Installation will serve: Residence alApartment House 0 rcial ❑Trailer Court C Motel ❑Other................................:...�...... r. Number of living units.-.-......... Number of bedroom sl"°.0--Q..Garbage GrindsMb ................ ......................... Water Supply: Public System and name Y --------------------------------------- ..: .....---... ....._... .................Private Character of soll to a depth of 3 feet: Sand ❑ Silt❑ Clay Peat❑ San Clay Loam ❑ V Hardpan❑ Adobe ❑ Fil aterial ....... pe ... .......... ............(Plot plan, showing size of lot, location of system In relation els, buildiust b placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit ,permute i public sewee wit in 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK I ] Size. ... ' Depth Capacity ------ -a,4'Tip ' ---- otLrial...................... No. Compartments ...................... Distance to nearest: Well _-'.�.___. __-- --__f___._Foundation Prop. Line ........-•--• .................. LEACHING LINE [ ] No. of Lines ------------------------ Length of ine............................. Total length ....................._...__. 7_77_ D' Box ....". Type Filter Material _.. .. ......:".Depth Fitter Material ...... ............ ...................... � i Distance to nearest: Well ....................... F undation -.-- _-------------- Proper Line ....................... SEEPAGE PIT [ � Depth --_--------------- Diameter .-------_------ umber ....�". .................. Rock F Iled Ye s ❑ No ❑ Water Table Depth - Distance to nearest: Well -------------------_-... ........Found ion .......•............ op. Lin ---_........-.--...... REPAIR/ADDITION(Prev. Sanitation Permit# __.-...-_.---------------------'-- ------- Date _ _ } j Septic Tank (Specify Requirements) ------_---------- Disposal Field (Specify Requirements) ------10.-----9W------ � (-tea' 1J -------- ---- -- ---- - - - ------------- - (Draw existing and required addition on reverse side) ��I� , .y,�,(�� I hereby. certify that I have prepared this application and that the work will be done In act rda c�'Wltl� r*�in Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son 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 become subject to Workman's Compensation laws of California." Signed -- --=--------- Owner 1. BY .... .. E ------------------ ---------------------- ritte ...�GG (if other than owner) I eq"EARTNIENT USE ONLY _ APPLICATION ACCEPTED BY ".-. ----------- ----- --- --------- DATE ` _ BUILDING PERMIT ISSUED --------------•------------------ --------•-------_ ---•-----_--------------- ---- ----------------DATE --------- . ADDITIONALCOMMENTS ---- -----•-- ••--- •--- ---------- -------••-•- ----•-------•-""-- --....-------.-.-- ----•-•--- ....... ........____--_-------------•----..--......- ............... •--------- ---•-•------- •--••--------------------• --•--•-------------- ............................................................ -------- ....... .....-"........ -.. .------Bate ...........final Inspection by: -•--- EH 13 24 1.-68 11ev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M