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FOR OFFICE USE: PLICATION—R)R"SANITATION PE �! Permit No'_7 -_--�o lCotnplete in Triplicate) C f .... 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 described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: JOB ADDRESSAOCATION - ...... .NVQ.-I....... .- I N 114 ... •. .................CENSUS TRACT .......................... Owner's Name tip-E�•• Lcw tJ ........... .................._.._-_..._ .................................... -------- ----- Address �41p..9.. N -1W 1 Phone .............`-:....__....-.:....._.. ----.. ,. .- City -..._ .i Oc: iCi01� AA .. . ..................... Contractor's Name .- _-. .-.�i�. - ��r�i5 N -�Q- f5 --.... . . ----------- ---.License # �q--�� 3__ Phone ..�l�6•-��6d 1 Installation will serve: Residence [:1 Apartment House ❑ Commercial Trailer Court ❑ Motel 0 Other ..-- - . •.... _ Number of living units:-. -_. . Number of bedrooms --S-5____Garboge Grinder ...-_ . .. - Lot Size ......................... Water Supply: Public System and name ........-------------------------- -----------------• --.................- ---------Private Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam ❑ Hardpan ❑ Adobe � Fill Material If _-- yes, type ......... - . )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,) PACKAGE TREATMENT } ] SEPTIC TANKf Size._.-.-.. Liquid Depth .......................... A � Capacity .. __.. Type ..... . .......... Material..._...- .... . _ -.. No. Compartments U Distance to nearest: Well ...... --- -- ---- ------Foundation -. _-..__..-.. ....... Prop. Line --------------------- 19 LEACHING LINE [ ] No. of Lines . Length of each line . .-- --_ Total Length 'D' Box .. Type Filter Material ....................Depth Filter Material _.................. Z Distance to nearest: Well .....L.. .............. Foundation _. .....-..........__ Property Line .._• ................... ' SEEPA GE PIT [ ] Depth ...... Diameter _______________ Number ... ..___ Rock Filled Yes ❑ No Q Water Table Depth -----------------------Rock Size .. �r Distance to nearest: Well ...-------------------- ________________Foundation --• --.... - -- .. Prop. line .......... REPAIR/ADDITION(Prev. Sanitation Permit# ........ --. - -- ___ --- Date ------------- ___________________} Septic Tank (Specify Requirements) .._ . ........ Disposal Field (Specify Requirements) _____ t.._.-P,'r" ._... . . . - _ ------------- - ------------ ------------------------ ------- ---•- - {Dra'w existing and required addition on reverse side) I hereby certify that i have prepared this application and that the work will be done in accordance with Son Joaquin County Ordinances, State Laws, and Rules 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 subject to Workman's Compensation laws of California." Signed . Owner By .... - Title {I of er than owner) OR DEPARTMENT USE ONLY APPLICATION ACCEPTED B c.. .- DATE Y:7 . - ...... . BUILDING PERMIT ISSUED - DATE ADDITIONAL COMMENTS - ............ •----- --- ----- Et --- ........ Final inspection by: . .---- - —7 ----- --- - Date .. ---------•--...... SAN JOAQUIN LOCAL HEALTH DISTRICT 4 E. H. 13 24_l-'4-8Rev. 5M __ �._ 7179 1 H