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i.� T*r��? Sr,,}_. 11�� Y �. �tr i ` ' 1 f I7 ^'� �tiy A Vii°3-0� �y�ui. A -. '+• a pt6� y r.i. rs.• -Z* - ,�?wi -��L �h4 >".�i'�iitiiR� � c' - - x _ _= Date issued . --------- ? This Permit Expires t Year Frem Date l�sUed District for perm, to con l 21,1111V-�IIIIIIIrork herein Application is hereby:-made to the San Joaquin Local Health p described. This application is made in compliance with County:Ordinance No. 5A9`anc�yexisting Rules and Regulations: JOB ADDRESSAOCATION ...c�1� �'.- /f 6� ... �nf ... CENSUS``CRACT ....... . ' ..._. ....... - .....Phone ., ........... We- Owner's Name • - ........ •• ......... ......----...... CityAddress 171.x. Intone I 't!•�d- -.. Cllc > .._........License9l�.. //• . Contractor's Name Installation will serve: Residence jM Apartment House C] Commercial{]Trailer Court (J Motel [3 Other i Number of living units:.._....... Number of bedrooms Garbage Grinder Al Lot SizeuL � Water Supply: Public System and name -.----•........:.................._---.........,:..............._..........................................Private Character of soil to a depth of 3 feet: Sand j] Silt❑ Gay 0 . Peat 0 Sandy Loom 0. Clay Loam Hardpan❑ Adobe fl Fill Material ............if yes,tyke ............... ............ (Piot plan, showing size of lot, .location of system in -relation to wells, buildings, etc. must be placed on reverse side.13 No septic tic tank or seepage it permitted if public sewer is available within 200 fee#,} � NEW iNSTAEEATION: ( p P P # .. Size...PACKAGE.TREATMENT [ ] Sti'TIC TANK I. - ....... Liquid. Depth Capacity Material....---- ••--- No. Compartments .............. Distance to nearest: Well ..Foundation ... Prop. Line -� ............... ;tel LEACHING LINE i ] No. of Lines ._:..._•................. ............... Length of each line............................. Total Length .......................... e •. l Filter Mate sal Depth. Filter Material ..................................I.....•••• 'D' Box ------------ Type :............. ::`Foundation Property tine ' Distance to nearest, Well ----------- ------- ....................._.. SEEPAGE PIT [. J Depth .......:...... .:.• Diameter .................Number ............... Rock Filled Yes 0 No 0 Water Table Depth -........Rock Size --•----••---•-----•....----••. , ••................. .. . Prop. Lina . ..............................f=oundation ................... ...................... Distance to nearest. Well i R9PAIR/ADDITION(Prey. Sanitation Permit# ...............................•_.. ,'-- D ... to �1 '.. ..lr................... . ..... � � Q .... ' Se' 'Ic:Tank (Specify Requirementsl ••--••--- -- - -- ------- - -- -- -- - �• - ---• -- --- - Di osal Field (Specify Requirements) ----- --•-- ..................... ......................... --------------- -------•-••-• ...... ... -------------------_- - ----- •-•-----•-•-•-----. - ------------------- i (Draw existing and required addition on reverse side) i+ereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Ordinani as State Laws, and Rules and Regulations of the San Joaquin Local Health.Dlstrict. Hama owner or iicen- sed agents signature certifies the following: "I certify that In the performance of the work for'which this permit is Issued, l shall not employ any person in such manner 1�as to become subject to Workman's Compensation laws of California;_." . �. Signed ------ ......... ---- -- ----- • . ..... ------ Owner ' Yitle --- .........:..... --- ........... (If other tha o er) FOR QEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------ DATE ..:.. ......2- � -BULLDING':PERMIT ISSUED -------------------=----------------- ---------•----------------•--------------- -- ---DATE .. ....... .............................. ADDITIN ', 'COMMENTS ---------- ------- •------•--------------...----------- ---••---- ------ •••-.......:......_._.._....... - -- - ---------------- -- ------- .... -- ------ .......... _------ ------------------- :. mate ....a2 final Inspection hY' --�� . � •Ef..13 24 1-•68 Rev. 55i SAN f0 G2LiIN LOCAL HEALTH DISTRICT $ 71t 3M �,s .