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01 NrrL1%.A11VIV r% K ' uiiimiiwov rGKtv111 ''......... - - - .......... Permit (Comply a in riplicate) Date Issued ...._.). .:.......... -.--....-..._ This Permit Expires 1 Yea From Date Issued plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein :scribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: Y u . )B ADDRESS/LOCATION _.. .........5. ..._._.....__._._._......CENSUS TRACT ---5- -1..- ------ vner's Name ..............ACo_R.r-q q___._.._S.T.F5'T.1,a-P.---------- --- -- - --------- -- ---Phone .................................... ddress . 25.25.-�_ ... � ._ 11-?faF�.1 t..o.S�. . . . -- n/ ..... City .:. ...- S-C-A-L�-- .......................................... � intractor's Name _ .Qw N .P�. -- ---- --- License # . ...._. Phone --------_................... stallation will serve: Residence(> Apartment House f-] Commercial [-]Trailer Court ❑ Motel ❑Other -------- ------- - -- )mber of livingunits: Number of bedrooms !/ ,....._Garbage Grinder ./V0 Lot Size .... iter Supply: Public System and name - ----- . ..... ....................... __.--....------. •. ----- ---- -----------...............Private ! aracter of soil to a depth of 3 feet: Sand D Silt❑ Clay ❑ Peat__ . Sandy Loam'❑ Clay Loam F!!�� Hardpan Adobe ❑ Fill Material ..!.V.o... If yes, type ..................... ...... of plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) W INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) _1`w -CKAGE TREATMENT ( ] SEPTIC TANK[ Size........................ _ ........... ----- Liquid Depth ....._.__.._.._... ...... Capacity ...._ ... . Type ----------------- Material-.... _.. ........... N Compartments ......................Distance to nearest: Well . .................... ............Foundation Prop. line ...................... +CHING LINE [ J No. of Lines Length of each line_. .._.. . . Total Length ....--. 'D' Box .._ Type Filter aterial ... ........ .......Depth Filter Ma rial ..... . .._..._.._------------------------ Distance to nearest: Well .. . ............ Foundation _... ..... ... Property Line -PAGE PIT ( J Depth ... _.. . ...... Diamet r .. Number _ Rock Filled Yes ❑ No ❑ . Water Table Depth ---- -- --------- - -- ------ ---------Rock Size .......... ........---------- -- 1 Distance to nearest: Well ... ..........................Foundation ..._ . ............. Prop. Line 'AIR/ADDITION(Prey. Sanitation Permit�#' --_.... .. _._ .. .. . .... Date .......... ..... --------------I ieptic Tank (Specify Requirements) ._............_........ ....... _ ........................ )is osal Field (Specify Requirements) -----P1ST--.....73QX:. ....... 5C.. - ._-OF_ �y. _ IF-4 H.. 4I.N DAr1l - _ l�� _y� _ S�En, �.. P(T..... f x x. /y (Draw existing and required addition on reverse side) �reby certify that I have prepared this application and that the work will be done in accordance with San Joaquin my Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- agents signature certifies the following: \ ertify t in the performs e o -the ork for which this permit is issued, I shall not employ any person in such manner o bec subject to Work a iC0�e ation laws of California." ed Cr4 h Lac , 24 r Owner _ T((7.0,_ Jitle (If other than owner) FOR DEPARTMENT USE ONLY i LICATION ACCEPTED BY TiJ� `�` . _ _..... ......... . ............ DATE �'-- -DING PERMIT ISSUED _ .. . DATE ... _. )ITIONAL COMMENTS - __ _ _----------------- ---------- ......--•- ... l ----- - -------. .... �, y..._.....-----'... ...... ............. //. .... _ � . Ins ection b ._-. � �!�... .-..-Date -! _ - ------ ..... n: SAN JOAQUIN LOCAL HEALTH DISTRICT . 9 1-'68 Rev. 5M i