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FOR OFFICE USE: — -� -------- /_�o APPM ".- -__��.� ,� �,•s 1lCATiON FOS..-SAIqiTAT10N PERMIT -- ---- ------ - . t (Complete in Triplicate) Permit No. ------------ This Permit Expires i 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 k described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION s� --- -------CENSUS TRACT -----------_ Owner's Name - - ----•---_""-• 3�h�---�----bar - --------------------- - -'----- Address Phone --------- -- ------- ------------------------------------------------ cit STK r1s�7�tS ►. --- -------------- Contractor's Name --- -- e'1'.� -- - ----- -------------- - ---- ------ --- ----------- •- ------ -------------------------------- - -- ---------.License # - - ------------- Phone` 6Sb D Installation will serve: Residence -3"--'----•-- �Apartment House,[] Commercial []Trailer Court i0 II Motel [71 Other Number of living units..---I_-".r_. Number of bedrooms -"a_2_- " I -Garbog a Grinder ----------- Lot Size S_41__X-"Vb�l----- f Water Supply: Public System and name C 1 1 �/J4 ee C ara4ter of soil to a depth of 3 feet: Sand' --------------------•------------------------- ___Private Ej ❑ Silt E] - ""•Cia Y ❑ Peat❑ Sandy Loam E] Clay Loam ❑ Hardpan ❑ Adobe g Fill Material NI ifes type ype ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: {No septic tank or seepage pit permitted if public sewer is available within 200 feet,} d PACKAGE TREATMENT [ SEPTIC TANK[ j Size_", X f ------------------ Liquid Depth ._ ;;�--------• - Capacity -"_ 034- Type ----------- -------- Material �._-" No. Compartments Distance to nearest: Well __ -----------------------Foundation 1b-------------- Prop. Line -:�� � ""_-":____" LEACHING LINE .._ I ( ] No. of Lines ------I----------------- Length of each line--"__9.0_"------ ------ Total Length . 'D' Box ---- ----- Type Filter Material s, __VgcX Distance to nearest: Well -Depth Filter Material ---- _9.11____ _-�_-� _ .___-"- _ � SEEPAGE PIT ' r �t --------- Property Line -_- �� ( ] Depth -- --5------_ --_ Diameter ___ Foundation "__ _--- -_--- Numbe- ------- -- Rock Filled Yes No CWater Table Depth ----,©D� �� I -----------------------------------Rock Size - -'� Y ------A Distance --------------- to nearest: Well _-.---N(11-_----_---- _ Foundation ._ ------------ _-_-- Prop. Line ---- REPAIR/ADDITION{Prev. Sanitation Permit# --------------. - ----- -------- ------- Date ------------------------.----------1 Septic Tank (Specify Requirements) ----______________, -------- ------------------ r ------------------ --------------- " "isposal Field (Specify Requirements) --------------------------------- -------- - - - - --------------------------- ------------ - --- - - -- - ------------------------- {Draw existing and required addition- on reverse- -- -s-id- -e) T ----------- 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. Horne owner or licen- sed agents signature certifies the following: "I certi that ' the performance of the work for which this permit is issued, I shall not employ any person as to ec m bject to orVn's Compensation lawsofCalifornia." in such manner Signe / /11_-l./- ---------------------------- ----- Owner --------------------------- BY - ,. . ------ --- ------ Title (If other than owner) --- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------------- --- BUILDING PERMIT�ISSUED ---------------- - --- DATE -" "- ADDITIONAL COMMENTS DATE = =a�---= G _ - --------------------------•---------------- - ------------- ----------------------- --------------- - -------------- .��- ------ ------------ ---------------------------------------------------- - ------------------------------------ Final Inspection b �T ---- -------- Y - ------- --N, ------- ----------- ---- - ------- ------ ------ -Date - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M.