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'FOR OFFI-CETSE: (`• - •.�. FOR OFFICE USE: ANIf1TION PERh±�'I .- (Complete in_Trio�kcate) Permit No...--77— . ............... -. . -• This Permit Expires i Year From Date Issued Date Issued...f . s -7;7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install tthe work herein describe This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATIO _:..--- CENSUS TRACT..----' ....... ---------- 4 Owner's Name..._-__ rad - ----- Phone Address �3 :.... ----------- --•- City . .. . .... •.� ....... ----- Contractor's Name.-:----.•.-••. - ; � �_ -----...; -------- t •-----••--••----••----• -•-•---_-.._ ...-- . --..--_'. ..i _ - en: #.off...`S3 one `l��s7 Installation will• serve: esidence❑ Apartment House❑ Qmmercial • Ti er Court ❑ Motel ❑ ;Other--:1_ �'' • Number of living units:_-*..._..... Number of.bedrooms.;,.....:--._.Garbage G_ri�aer. Lot'Size.,.-Q! -•-_ W ter Supply: Public,System and name_.__- �::::' ,:: ; = - -� __ r .. _�-. (_ .. i - Private :... :. Character of soil to a depth of 3 feet: , Sand ❑ 'Silt 0 Clay❑ ` Peat❑ `Sandy Loam Clay Loam ❑ Hard ars .. P ❑ ; Adobe•❑ Fill MafeTial f YeS,tYPe ' -`---_..... • •------ LR � � (Plot plan, showing size of lot, location of system in rdlation f'o:wells, buildings,'etc.'must be placed on reverse side.) NEW INSTALLATION: (No`septic'taank or seepage pit' permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT [ ) , SEPTIC TANK ' r �• . f! Si e.----.- ...-• 5 -- :-- �o �� -------Liquid Depth------------- _ P tY- --------- ------ a_•._:._ _ Material._ ':.__:_..No. Compartments..__-_7 --.--__ i i Distance to nearest: Well...�l :.,__.._ „__,.:,:_-.,Foundation... ...� .____ �j� • .....Pro . fine::_.> !, LEACHING LINE [ No. of Lines........ ............Length of each line d ,-__-__Total Length __ dam............................ 'D' Box..: ....:--Type Filter Material,5i?C. :_;Depth Filter Material...f _�__._.--; Distance to nearest: Well./QD... .__.._: ...Foundation.. •Z_4. ---_----_-Property Line._ . SEEPAGE PIT [�j' • Depth.__,__-_Diameter..... -- ......._Number---- -. ............••. r/ y Rock Filled 'Ye No Water Table Depth...:. _•.._--___ Rock Size__ 1' i i Distance to nearest: Well...15Z._____ - = = Foundation.. . .:.-----...Prop. Line..--...-• -•-•----• .-- REPAIR ADDITION (Prev. Sanitation Permit#..:.-...- --------------- __._..Date......:.......... ----------------------- Disposal.Field (Specify Requirements).-_..._-_........... Septic Tank (Specify Requirements).....:.......::. . -------------------------------------------------------------------..-:-. ---=-- ................... -•--....... •------= - t ---- ----------------------- -------•--- --- ---- - --------------------------------------------------- --- -----•----•- --------------- -- (Draw-existingg—aan�d7equir4,addition on reverse side) I hereby certify that 1-have prepared this application and that the�•iNork will be done-in accordance with San Joaquin County Ordinances, State Laws; and Rules and Regulations of the Sari Joaquin Local Health District, Home owner or licensed agents signature certifies the following: -T "1 certify that in the performance of the work for iwhich this permit is issued, I sFiall not employ any person in such manner as to ben ub t to It 's Compensation'laws of California.,, Signed-- •-- r ...4.... _. _. n ------ - ------ -------Owner y..._- ' :{ Tile. (If oth r than'own'er) •FbR•DEPARTMENT USE ONLY` APPLICATION ACCEPTED ...-` ---- DATE.---- ---�-----• ---------- .. DIVISION OF LAND NUMBER—..... .:....... ... .. , TE `--- ----- -----------------DA .. ADDITIONAL COMMENTS �.:........... .._ -------------- ----- ---------------- --------- v - ---------- - - Final Inspection by--------------------------- ..-•---••----. . _- Date... --..........�. EH 13 24 SAN .10AMIN ±nrn± uIZAITU nicro:r•T