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t rpt-wt.tl,Nttc� Wk SNfVlll/�!i[tiN .............. I - (Complete In Triplicate) � Permit No. .7.,7��.. This Permit Expires ] Year From Dc1i Issued Date Issued Application ris hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein. described. This application Is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: 3-7 JOB ADDRESS/LOCATION .'I ..-..(�. • I ..................._. Owner's Name v/ ...,.`C .... ....... Y�!! .!q. .� T { - .............................. .... ...,.. ....Phone , Address . . .. .....'... ., ..7.fs --P.r s..... ...................I........... city . . ...... Contractor's Name _.-Svc-Irk .. ....License - - . - . _.._ . ._...... . -• ------- ------•- ...�:�.`F.3...... Phone Installation will serve: Residence 0 Apartment House fl Commercial ❑Trailer Court 0 Motel ❑Other Number of living units:.._(..... Number of bedrooms Garbage Grinder Lot Size I! ,l ... � . ....................... Water Supply: Public System and namePrivate ............................................----.......................... Character of soil to a depth•of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Cloy loam Hardpan ❑ Adobe PT Fal Materia( type............ If yes, pa ............... ............ (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 taQk or seepage pit permitted if public sewer Is available within 200 feet,) ii PACKAGE TREATMENT f ] SEPTIC TANK f ] Size............................ Liquid Depth s Capacity Material................... No. Compartments ' -------------------- Type -------.......----.. Distance to nearest: Well .....................................Foundation _ prop. line J LEACHING LINE [ ] No. of lines ......... 00 .. . .......... Length of each line............................ Total Length .......... 'D' Box Type Filter Material ....................Depth .Filter Material ............. - Distance to nearest: Well ........................ Foundation ..... .................. Property Line . . . .. ..- SEEPAGE PIT Diameter .... Number ........._1111......... .... Rock Filled Yes ❑ No i❑fp ( 1 Depth 1111_....-- , Water Table Depth ................................................Rock Size ..._........_...... Distance to nearest: Well ......................................... .. Prop. Line .................••---•• --•_1111.--------• 1111.................. RI:PAIR/ADDITION(Prev. Sanitation.--Permit�# ............................................ Date ....._........- - ..� .................................. Septic Tank (Specify Requirements) ...:......:.... ) �} .. .............•................................................................ Disposal Field (Specify Requirements] •---- !---._.�_7 Q -. ,.r.................----- ----•---.... ....... ...... .. --------•-----•------......I..----•• •----------•-••---- ......................,_..- ................ (Draw existing and required addition on reverserside) .'' I hereby certify that I have prepared this •application and that. the woik-will"be done-in accordance= w(th'San Jeagttin County Ordinances, State Laws, and Rules. and Regulations of the Son Joaquin local Health.Distdcf. 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, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ............ Owner By ----- --------- -- -- ..` .. , --------•-•--..._.-•.................... Jitle -. - (If othe hon owner) -11:11........ ....:.....1.111.. .......... _- FOR DEPARTME USE ONLY Y APPLICATION ACCEPTED BY _.......... _ ... - . ,. 1'.. A dLr�C' .` BUILDING PERMIT ISSUED .._.._.._.1.111------------------------ -- x ( !`:,__:...._.. GATE . .). +fib'.?1..... ADDITIONAL COMMENTS .�..._ %... .................DATE ......_. ............... -------------• --._..... ...... ---------------- ....... ................ ............... _.._..._................._... ............. ........................................"I......... .-. Final Inspection by: .................:................ . - ----•- - 1.111.1111---._............. . ... .: _ EH 13.2 �.-6t3 lZev. 5M 1111__ 1111_--• SAN JOAQUIN LOCAL HEALTH . STRICT 8/7h 3M