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FOR OFFICE USE: �. APFUCAWON FOR SANffAY10W PMM......................... � . . .............................................. (Corriploto in Triplicate Permit No, _ -'................................ ThisPermit Expires ] Year From Dato Iaaued Date Issued Application is hereby made to the,San Joaquin Local Health District for a permit to construct and install the work described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations:herein JOB ADDRESSAOCATION --- ---�--- ------------ ---- - - ---••------•-----��t!- CENSUS TRACT .-------------------..._: Owner's Name ..._ Address .------•----- Lir -- - - -----. --•------. -------_--•------ -- ---- - ..................P one -...-•-----'�•- � � •-----.................. GJ- ...A�cl,......city ............... .....�. .......:................ Contractor's Name }-•d---- 4Ajcansa ... Phone 44e,7.7-R-O? Installation will serve: Residence PyApartment House❑ Commercial OTrailet Court 0 Motet Q Other.-•------•-----------• = Number o#-living units...../_. Number of bedrooms -%? _"&----____.Garbage Grinder .�_ __ Lot Size ------�r__-•_______________ _ •. Water Supply: PublicSystem and risme --•--...._..__ -r ----------•----------------•--•------••-•----••-•__Private OC j. Character of soil to a depth of 3 feet: Sand Silt Clay 1 _... ❑ Y ❑ Peat❑ Sandy Loam Q Clay Loam.(:] JJJ ~��'�► .� 1nt'�_lrir• w _F11FW.••�„—+r4'.fTd if Hardpon[� Adobe❑ Fill Material Ifes typo (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed onside.)reverse NEW IWSTALLATION;. (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK 'r _ Size_-- __-- �s- ,��----�-��----------- liquid Depth __�--------.-__-_ Capaeity/'10�0 6t T i�r�� Matoritel_ Go-�e.�ra No. Compartments o2 ....._......... Distance t1i nearest: Well l --------------_ __...Foundation ----------_-------- Prop. ---_.__r `' LEACHING LINE = No. of Lines ------s.�------------- Length of each line------red - ----- Total Length -Ad_ =t s'D' Box ../...... Type Filter Material :p _Depth p Filter Motorial ! ..... Distance tc_ nearest: We11 ___ ............ Foundation _lam_-------------- Property Line ._447........... SEEPAGE PITt [fj-10� Depth ------- Diameter -�l_..------ Number ------�---------------- Rock Filled Yes No _Sg a Wcftr Table Depth ...-�--------------------------------•--------Rock Size................................ f 2Sf10 lai Distance to nearest: Well ...._-----------------------------------Foundation ..................... Prop. Lino ...................... REPAIVADDITiON(Prev. Sanitation'Pemnit i!i t---- -------------------_----------- h Date ---------------------------_----- Septic ----Se tic Tank (Specify Requiremerts) -----------•-•--- ---•-••----------------------•-----..__ ) DisposalField (Specify Requirements) .-•..............•-•---..____.._._..------•-•-••-•---•--•--------•--------•--....--................................................. -•------------••-------------- -- ++ ..................... ........ ----------- -------r------r....------......_.........._._..—..--T'•----------__:..___ =r-__.._:a..........•..............:_......................W. i 'iDraw'existing and required addition on reverse side) I hereby certify that I have propa�d this application and that tho work will bo dam in aeeordanco with Secn Jw gt;iat County Ordinances, State Lairs, m6a Runes and Regulations of the San Joaquin Local Hoatth District. Homo owner or licmi• sed agents stenaturo cortifies the following- 1 1 certify that in the porformaneo of the work for which this pormit is Issued, I shall not employ any peroon In ouch marxmor e az to boeomo sublaet to Workman's tomponsation laws of California." Signed --•-_-•---- ---------------------- ------ -----•---• Owner By ....._.... :... .� •----- title . ................................. (If other than owner) r ► -DIvPAt2T1~izm USC OxLY APPLICATION ACCEPTED BY 1 -----_--- •-•--- - DATE ... - BUiLDING PERMIT ISSUED _.. -- --- ........................DATE-------- .................................. ADDITIONALCOMMENTS ----------------E--•-----•--------- -----•--------••-•---•-----•----•----•---------------------------- ----------_-------- -- .._.. ._---- ----•-•--------------•--------------•-----------:-._.._.-----•---• •----------••--------.----•-..:-----•-•---------•------------------------------•---------•--------------•---------- ................--------------------- •------•------- •-•--•----- -------- ---------------•--=----•••--------------•---------------•-----....---------=---••------•--•- - - 1' -•---------- Final Inspection by: -•--_ ..._ �.._ ..... _.. Date �` _�' .. .... _. - . __. -- SAN°JOAQUIN LOCAL HEALTH DISTRICT _ E. H. 9 1-'68 Rev. 5M