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FOR OFFICE USE: R ITATION PERMIT SAN PPL.lCA710N FO y Permit No. i(Complete in Triplicate) } Date Issued _1_0_-_J_-5:___7J ---------_-----------------------------------------____ �' This Permit Expires i Year From Date Issued V, Application is hereby made to the n Joaquin Local'Health District for a permit to construct and install the work herein desuibed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- V.4 egulations: d �V JOB ADDRESS/LOCATION ---A. � 9_:� ,S - ---- ---- --- ------------------------ --------------CENSUS TRACT -----� ----•------ Owner's Name ______________ __ _ - - -- -�- _ - -- --- --------- - ---------------------------•--------- -----Phone �l/_---•--- Address = +J-- ------ --------------� -- _----- --- -- City. ------------------------•------- ------- Contractor's Name -------------'------ _,�C� ----- - --f-----o .cam------------ -------.Liven e # ---- Phone Installation will serve: Residence Apartment House❑ Commercial I❑Trailer Court ❑ Mote! E]Other - ------------- r d Number of living units:- ------ Number of bedrooms ________Garbage Grinder ____________ Lot,+Siie _ --------- _ .__..... Water Supply: Public System and name ----------------------•------------------------------------------------------ :Private k Character of soil to a depth of 3 feet-*-Sand'❑ Silt❑ Clay ❑ Peat'O j Sandy Loam ❑ Clay Loam:❑ ,Hardpan ❑- Adobe ❑ Fill Material If yes, type -------'-------------------- (plot -________(Plot plan, showing size of lot, Ioca#ion of,%system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:1 (No sep#ic ank o� se.,,page pit permitted if public sewer is available within 200 feet,} V i PACKAGE TREATMENT ( ]i. SEPTIC TANK` Si e______ ___ h ____________ Liquid Depth _7F3------------ A _______---- .f CapacityL` Type _ __ __-____ __�___ Material_�1t" ✓�____ No. Compartments -__--.- -_-- Distance to nearest-' Well __:_ d (______________Foundation ___AQ_____________ Prop. Line .------47-7------ LEACHING LINE No of Lines __ Total Length k ------------- ---------- Length--of each line----/'�--- -_.- -- _ - . � er Material PCO—.__.Depth.,-Filter_Material ____,lc-________-_____ _______________ D 'Box .______t. ype Filt Distance to nearest. Well SQ `-______ Foundation ----- Property Property Line ... , - ---------- .-z .Rock Filled Yes No dSEEPAGE PET Depth --- Diameter I)NumbM ,er i WafJ Table.Depth--------------------------- -------:_ Rock Size `��. i� �`---------- - r - Distance,.to.nearest: Well ._ -.10?9----------_______________Foundation _._�Q__"�`___ Prop. Line -------------------- il REPAIR/ADDITION(Prev. Sanitation Permit# -------•------------------------------------ Date --- ------------------------ n 1 f Septic Tank (Spec''ify Regdirements) -------------------- ' f= - f , . ., „ Disposal Field (Specify Requirements) ------ -------------------------------------------------------------y- ---- -►..1 I ---------------------------------------------4-------------- ----------------------7777777 `' ss 4..4, 1 I _________________________________________________________ - t (Draw existing and required addition on reverse side) 1 hereby certify that 1 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 liven- sed agents signature certifies the following: 1 s "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 become subject to Workman's Compensation laws of California." Signed -------------------- -- ------ ------ Owner By ------ ------- ------- - -------- Title - - --------------- - --------------------------- (If other tha - wrier) FCWDEPARTMENT{USE ONLY I APPLICATION ACCEPTED BY __ ______-- DATE f�__-:c'p� -7 J-------------- - ------------------------------------------- - BUILD !NG PERMIT ISSUED --Ii-------------------------------------------------------------------- --- ------------------------------DATE ------------------------- _.,� ADDITIONAL COMMENTS ------------------------------------ -------------------•------- - ----=------- -------------------------------------------- -------------------------------------- Fina! Inspec#ion bY: --------------------------------------•-------------- ----- --Datelj SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M