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T �'►PF4C � .. �l,y n ---------------- --------------- This Permit Expires 1 Year From Date Issued Date Issued ----- Application is 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: JOB ADDRESS/LOCATION --------� --7--------------5-----1 //V N-A- d------�-�-��'t_�r CENSUS TRACT J -a 4 i - Owner's Name e 17 ��ca �'I ' Pry � -------------------r-------------- - Phone Address -/. $`�.-- LLQ 4/lvN, _o/ 1�� City ��O��C�^z------------------------------•--------------------- 94 Contractor's Name --- /Z— OP ---------------License c3- � ----- Phone Installation will serve: Residence g Apartment House C1 Commercial ❑Trailer Cou COPY fMotel E]Other -- ---------------------------------- Number of living units:----- ---.. Number of bedrooms-__-__Garbage Grinde lot Size .. i��'ffk Water Supply: Public System and name ---------------------- ---------------------------------------------------------------.........................Private Character of soil to a depth of 3 feet: Sand K Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe ❑ Fill 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.) N ' W NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK [ ] ze---------------------------J --------------' iquid Depth _--_-.----__--__--___----- Capacity -------------------- Type ----------- -------- Material--------- ----- No Compartments --------------- •..... C Distance to nearest: Well ---------- ------------------------Found _-__-_-__ _ _-_---.--- Prop. Line --------......---..... LEACHING LINE [ ] No. of Lines -_--_____--____--_-_- Len th of each line-------------------------- - Total Length .__._.__..............._.__ D' Box ---.._..---- Type Filter Mat rial ____________________Depthr teria( ____________..___.__.____...___......._...._ Distance to nearest: Well --------- -------------- Foundation -- ____ _---_--_ Property Line -----._-_-.-_ ......... SEEPAGE PIT [ J Depth -------------------- Diameter ._---_:-___--_-_ Number _...___ ___ ..--.._.__ Rock Filled Yes ❑ No ❑ WaterTable Depth -------------- ------------ -------------------Rock S -----------•----------------- Distance to nearest: Well ____ __________________________________Found _--_.----.-___------ Prop. Line _-----__-•-__----__---REPAIR/ADDITION(Prev. Sanitation Permit�# .......... ................................ Date ___ .....__---_-_-_______-.-) Septic Tank (Specify Requirements)' --------------- j------------------------------------------------------------------- ----------------'--------------------------------- Disposal --------------- -- ----------- Dis osal Fi'Td` R uiremensj`- ! -------/ - ----- /�--'�-� C!,l? /6i1� , a p _ - -- - � � ------------------------------------------------------ t 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: k "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 ---------------- --------------- ----- ---��-�- ------ -------------------------- Title - - - - - - -------- --- --------...----•----------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- I -_C/-------------_. ._.._ ._. _ DATE ------ .__."'._ = •--------------- BUILDINGPERMIT ISSUED ------------------------------------------------•----------------------------•-----------------------•----DATE ------------------------------------------- ADDI-T--I-O---N--A---L- COMMENTS = ------- --------------------- ---- ----- -------------- - - --------- ------ - -------------------•-------------•----------------._----- --------------------------------.--.--.--.--.--.--.--.--.--.--.--.--.---.---.-- -.--.--.-- --••---•-------------------•- --------------------- ----------------- --- - - - -- - --- -- - ----- - -i.. --------•------ _----- ------------- Final Inspection Date SAN JOAQUIN LOCAL HEALTH DISTRICT r N 0 1_'A.Q Dn SAA