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-- ,vn aA,NB rAr wm rcKmii ............................... (Complete In Triplicate) PttrmN No. ...7.r'.'. ........ This Permit Expires i Year From Date Issued Issued ............. .... . . Application is hereby made to the San Joaquin local Health District for a permit to constrt,4 and Install the work herein described. This application Is made In compliance with C u ty Ordin nce No. 549 and existing Rules and Regulations: ""JOB ADDRESS/IOCAEON ...3....... ....._.- CC.-...............�i/' ...............................CENSUS TRACT Owner's Name ...u` ..... ,... -. a . ._.................................. .. hon .... .. . Address 3G .S...../"V'.':�x"rz'=` City .._ .r'$a.......................................... .. .......................... Contractor's Name ------- �•.... ..........................License # . is ... Phone Installation will server Residence 8Apartment House Commercial ❑Troller Court ❑ Motel ❑Other----• -----------.............-........_ Number of living units: .-3-.._ Number of bedrooms .-s----Garbage Grinder ............ Lot Size lJ !�.. .............. Water Supply: Public System and name --------- .. ......... ....__ . ......... .... ------..._...................-•----.................Private ®s'i Character of soil too depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam ❑ day Loam ❑ Hardpan ❑ Adobe 111 Material ............ If yes,type............... ............ 'Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) DACKAGE TREATMENT [ ] SEPTIC TANK[ Size................................................ Liquid Depth ....................... Capacity ..... Type .................. . Material...................... No. Compartments ....................0 Distance to nearest: Well ....................................Foundation ...................... Prop. Line ..........._........ _EACHING LINE [ ] No. of Lines ........................ Length of each line............................ Total Length .........................j� 'D' Box ............ Type Filter Material ....................Depth Filter Material .........................................15, Distance to nearest. Well ........................ Foundation ........................ Property Line ...................... . —oEEPAGE PIT ( ( Depth Diameter ............... Number ............................ Rock Filled Yes ❑ No Water Table Depth ...... ............................ . .......Rock Size ................................ E� Distance to nearest: Well ........................................Foundation ............ ....... Prop. Line ..................._. REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date ..................................) .ieptic Tank (Specify Requirements) ............. ............................ ».... _.........`...... ..........».... ........ . . DiSDOSa FieIP (Specify Requirem ts) --. .... ... . . ✓�J .....1P..0.... ............................................. fqf� .....,r... .... _..._...._......... _._..------_ ---------..... .........._........ .................................................................................. (Draw existing and required addition on reverse side) 1 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 certify that in the performance of the work for which this permit Is Issued, I shall not employ any person in such manna as to beta ub act o Work - Com ensation laws of California." S.oned .............. Owner By _ � `�� ..... .. Title ...�. —__ .. (If other the caner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ..... ..... ........... ................................... DATE 3a..7G. ...... BUILDING PERMIT ISSUED _...... ....... ...........-...... ...DATE _......................... ...... ADDITIONAL COMMENTS . ....................... ................................. ....._. ..................................... .... ......: .........................._...............I...... _.. .. .................................................... .......................I................... ....... _...................................... -- ......._ ..... ..... . Final Inspection by: ................. .........................................................Date . ..711?10Z.- ..?.Z................. gi 13 2!s 1-66 lfnV. Qt SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3H