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A%rrLi%, iiwrt rqjK bAN11A1rcaM rum"I Permit hlo. ..........: .... .......:................ ......................:.... �a..� . [Complete in Triplicate) -- -_ .. Date issued ..5:..•.•••••••• i This Permit Expires I Year From Date Issued I Application Is hereby made to the San Joaquin Local Health District for a permit to construct 9 d install the 9 ork herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Re ulations, i JOB ADDRESSAOC�ATTION ............. CENSUS TRACT ' ....... Owner's Name .i2-''t....._ ........................."7 ............... ... ...... ..................::Phone. .........._..........._._. Address . °�Ld ....lr�..-.1, .... '°................................•_........City �•` i i nee #` . Phone Contractor's Nam® !2P'.tl`�-.... ...., ...__... Installation will serve: Residence Q Apartment House 10 .)Trailer Court ❑ Motel ❑Other............................................ . . Number of living units:-;........:. Number of bedrooms Garbage Grinder .-----._.... Rot Size ......... .............. ..._._...._... Water' Supply: Public System and name ........... -.-..._...:. _--------------------.......•...........................................Private Character of soil too depth of 3 feet: SOME] Silt❑ Clay M Peat❑ Sandy Loam.'¢ Clay Loam ❑ Hardpan❑ Adobe❑ Fill M6terial ............If yes,type ........................... Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) S P � g NEW INSTALLATION: (No septic tank or seepage,pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAMC V4 jSize.3. /D r........ . Liquid Depth ...........--................ A Capacity ._ ..... . Type i�,w.e w .. Material...�'�....... No. Compartments -_2e............... ; e 1 1 _ Prop. Line � ...Foundation __�_....._. ._ ...�"� Distance �o nearest: Wsli�:�....��---------------------- ----• g .._,......... EACHING LINE No. of Lines .-�________________'. Length of//each line....SP...--............ Total Leepn th .da_ .......-••-•---•:.� E; 'D' Box .Y ..... Type Filter' Material ../d. ......Depth Filter Material ..1.l..- .................•- Distance to nearest: Well ::70-'............... Foundation .7�-................ Property Line ..! ........... SEEPAGE PIT ) ) Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑£ Water Table Dep :.....................................Rock Size ............................. Distance to nearest: Well -------.-Foundation ..................... Prop. Line REPAIRfADDITION(Prev. Sanitation Permit# ..............................••- ....... Date ) 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 he done in accordance with Sots Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or 11011. sod agents signature certifies the following: j "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 bec a su61e to o_Aran's Compensation laws of California." Signed ; ��....d................... Owner By .... .. ......... . .. .. .................................................. Title . ...-................................................................. Of other than o ner) FOR DEPARTMENT USE ONLY C . APPLICATION ACCEPTED BY . . _ ..... DATE - :�6 7S" BUILDINGPERMIT ISSUED ...................................:.......................................-.....- ------ ------•---::..DATE..........................:-----. :...-...-..-. ADDITIONALCOMMENTS ...... ..................•--•-...--...............------.......•-_-_..._.....----------.............---...:....- ................................ ... . .................. ............. --......... ........----.........-_.. .........-•---- ............-. ..............................-....-................. ...- ....................•--••-- ..................... :--- ------- ....................... .......... . .... Final Inspection by: ..... .� f ...................................:............. Date . .'....2... .. ......... EH IS'.2h 1-60 Hao. +5l SAN JOAQUIN- LOCAL HEALTH DISTRICT '8/7h 3M r " % L I._.