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rvrc J,,►l.,;raslwl, nit No. e,r .. ...... AtorL14Mt P.J{-t .T (Complete in VIP"catel Dote issued .V.. A.-' ------- -- tires '{ear Frain DatelSsued Zhis�ermii Exp .._ permit to cUnstruct and ueSt�lndhegu a3�onseln uin Local Health County Ord noan a No. 544 and existing Application is hereby made to the Son }oaq fiance with Courn�tY .. "-"•-.••.••- described. This application is made in comp ,-%� CENSUS TRACT JOB ADDRESS/LOCATION Yom. '. owner's Name J2t�l. y City .. # -• •- n_ r Phone Address License Contractor's Name Residence Apartment House❑ Commercial ❑Trailer Court ❑ Installation will serve: Other ._." Motel El other ---------*-------- Garbage Grinder Lot Size . ._. ---- - .... -•--•- ---�•--"--- . -•---• Number of living units:_..-�____-- Number of bedrooms _,1-- • Private ------C Supply: Public System an name ------------------------ , Clay Loam Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam y ❑ Hardpan Adob Fill ❑ Material .._ ..__. -- If yes,type . ... buildings, etc. must be placed on reverse side.i {plot plan, showing size of lot, location of system in relation °f public sewer is available within 2d0 feet,} NEW INSTALLATION: (No septic tank or seepage p' permitted f�C 'el....... Liquid Depth ., .. PACKAGE TREATMENT { ] SEPTIC TANKA Size--_-•---• ----1•- --------- �p __ Material_ t-- No. Compartments .....2 -........ Capacity GI.C�- _....._ Type Distance to nearest: Well ..................Foun��djjation --_.. .t _�..__ Prop. Line ___...�..._.. _.... LEACHING LINE ` No. of Lines ----�-........ .-.._ Length of each line""...rj"(9.�•--------._ Total Length ------1. �--��-- 'D' Box J........ Type Filter Material . ._ _ _Depth Filter Material .............................. Distance to nearest: Well �0... ".---- Fo dation _.10 ..__... Property Line ...!-.��..__...... SEEPAGE AIT [ j Depth ..._.._...... ..... Diameter ------ --------- Number .... ................. Rock Filled Yes ❑ No Water Table Depth _"....----------------------_.................Rock Size ..... _.. . Distance to nearest: Well ._."....................................Foundation ....... .. Prop. Line ................ REPAIR/ADDITION(Prev. Sanitation Permit# ...............------••----------•-----_-- Date . ...............................II Septic Tank (Specify Requirements) ..-- ... . --- ----•---------- ...........•--------- ---------- -------------............................-----------•--------------- � Disposal Field (Specify Requirements) ............... - ---- ----------------- ....... .. . ........ ... ..... ....I- ---- ------------------------------ ---•----••----------.....---------- -- ........................ ---- - ---------- ------ --- - ----------._.. (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 certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as tobet bject to Wopkman's Compensation laws of California." Signeew -__ BY .. ...... .......................... ........................ w�, a Title (If other than owner) o FOR DEPA TMENT USE ONLY APPLICATION ACCEPTED BY ..... ------"------ ------------------- DATE ..._ - . BUILDING PERMIT ISSUED _____________ __ •... --�- --------------------------------------------------- - - --------•----DATE --..............----- ADDITIONAL COMMENTS ------------------ ----••------•-------•-•----------------••-------- -------.._.. ----•---- ------ V___ . Final Inspection by: _- 22. ......................................... --------- at SAN JOAQUIN LOCAL HEALTH DISTRICT E. H_ 9 1-'68 Rev. 5M j 6 �7 3-6 ,- f