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� I FOR OFFICE USE: APPLICATION FOR 4-ANrTATION PERMIT ......... ............ ............................... { Permit No. .�_ ... _ .�.. {Complete in Triplicate? �aV � -- -. This Permit Expires 1 Year From pale Issued Date issued Application is hereby made to the San Joaquin Local Health District for a ruct and install the work herein described. This application is made in compliance with County Or Onance Na. 549 and exiss and Regulations: cf 7 cam- JOB ADDRESS/LOCATION Owner's Name / 66. .7 :.... Address . ..� /{�.-i er!t, lde,�l�..4 ftb..�{ P, nD........... .....•... City ...................... Contractor's Name ..........& :...I' '' f ...44 ..........License # •..... Phone Installation will serve: Residence A Apartment House 0 Commercial []Trailer Court 0 Motel ❑Other ............................................ Number of living units:.... ..____ Number of bedrooms 14-_-----Garbage Grinder ._......_.__ Lot Size ._ - - ------------------ Water Supply: Public System and not ' 1 � I e .--._--_-----_--_.................•-•------......_...._�f:..;-,-••-.---......... ._.__ `°`� 'Private - Character of soil to a depth of 3 feet: San ❑ Silt❑ Clay F'ent'❑ Sandy Loam ❑ Clay Loam ❑" ; + ;• Y �,V a .:_..'.... �.._...... Hardp�n ❑ Adobe f& Fill Mdteri4�. If es,typ (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc, must be placed on reverse side.) . 4.4 , -42 1 NEW INSTALLATION: (No septic tank or seepage'pii-'permitted if public sewer is available within 200 feet,] PACKAGE TREATMENT [ ] SEPTIC_TANK'S ] Size...... ...................... ....... Liquid Depth ........................... Capacity .... g Type Material.....--------r --•. No. Compartments ...:........ Distance to nearest: Well -------------------------I..--•---..Foundation ..................I... Prop. Line ...................... LEACHING LINE [ ] No. of Lines+--------________________ Length of each line........--_ ......:..._._... Total Length .......I......-............. 'D' Box ._......--•- Type Filter Material ......:.............Depth Filter Material ....................................-_:-.. Distance to `nearest: Well ........................ Foundation ................ ., Property Line ......---............... SEEPAGE PIT [ ] Depth ._.....:_�..____.... Diameter ................ Number .__ ..........,•_... Rock Filled Yes ❑ No Water Table Depth .........::-�:.'�....Rock"Slze_!................... Distance to nearest: Well ---------------_ .....................Foundation -----._._. ......... Prop. line ....--_---_.....__..._ REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ................................... Septic Tank (Specify Requirements) ----••-•-•-•--..a.La ... --•-----_----•---•---------------- •---•---.---_ ----•-----•----••-.... Disposal Field (Specify Requirements) ........ 13 ?- --------- --- ' -------------- -------•--------.......-•----._.•..._...---------...-.....-•------ � X I E '1 ------------- (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 IRules and Regulations of the San Joaquin Local Health District. Home owner or licen. sed agents signature certifies the following: "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 su I et to Wgrkman's Corn ensestion laws of California." Signed ...... ... --,..yy.�------- - - - --------------------_ 1,(_._ i-_.._._...�e�� 8y .._.._. ............ 1 {�Q�,l/1_W..1---------------------------- Title ... .-•--•----- (If other than owner) w FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ... . -------------=---------------------------•• DATE -..._ I�.. �L_............... BUILDING PERMIT ISSUED -----------------....................................-------=............. ...............................DATE _.......................................... ADDITIONALCOMMENTS _--------------------_-- ........................................................ -•.._..................-••-•.._.-...... .... •---••............_ : .... A. ' .--• •-••-------• ................................................ :...............•-••---•-- ------ Fina( Inspection by: ..... . ---.Date .... _lD-_ l o................ SAN JOAQUIN LOCAL 2HEALTH DISTRICT c u 13 24 1_-AA P.- +SAA 7/723 ,14