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FO. R OFFICE USE: Y O R SAITATIONT-PERMIT FPermit No: 7Z- -S 3 [Complete in Triplicate) -------------------------------------------- Date Issued This Permit Expires 1 Year From Date Issued F 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 complip e wit County r in -e No. 549 and existing les and Regulations: _ _ X05 TRACT ---------------------• --- JOB ADDRESS/LO ATION F �- W -------------- -----Phone Owner's Name -- _�,-Xr.A-Y------ �--•---{'- '�- �--------------------------------- ---------------------------- ---------------- f ------------------------------ City ---=------- ;----------------- ---- Address --Address ------=---------------- G k Contractor's Name ----------1 _ �C�:. ��e ------------------------------------------License # _ _7� �' Phone _/- ------ Installation will serve: Residence [ partment House❑ Commercial ❑Trailer Court l❑ T Motel ❑ Other ---------- its: - - - -=-- --- -------------- �_...� �.. . ; __Garb� a Grinder s-- Lot Size zd_t�' d3�---------------•-- E Number of living units:__._.____ Number of edrooms __ ____ g Water Supply: Public System and __ __--t____ -t -- =—; --------------------------- Private ❑ I I Peat Sand Loam ❑ Clay Loam .[] i Character bf soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ o Y y Hardpan ❑ Adobe Fill Material !Q_____ If yes, type ------------------- (Plot plan,' showing size of lot, location of system in relation to wells, buildings, etc. must be placed to reverse side.) � ') see age pit permitted if public sewer is available within 200 fee J / NEW INSTALLATION: (No septic tank or - p' p � PACKAGE.TREATMEN7 [ ] SEPTIC TANK Size--- �-�'S --------- ------------ Liquid Depth ._y/-,------------- Ca acit . Type ^ No. Compartments _- —--------------- Capacity Foundation f p /-------- Prop. Line Distance to nearest: Well ........... -- ` ------------------- / 1 Length of each li'ne__�' s -_�,-- -- Total Length f _-------•- LEACHING LINE No. of Lines ----�---------- - g y i 'D' Box V-G.s.__- Type Filter Material P iter Material .__ __C[------------"=----1- r / ____ a �Z� -De th Fi r --,'- =-- Property Line --- ---------------- t{o nearest: Well _.__ �-- Foundation __ ` P tY" Diameter J -- Number. Rock Filled Yes � No l❑ ----------- Distance � SEEPAGE PIT .� Depth _Z�_--__--:. r — I i/ } Water Table Deptll------- ------------------------------Rock Size Distance to nearest: Well _____________________ :-Foundation -Ze---------- Prop. Line L .�.... �: ...- - ----- Date ------------------- ----------- REPAIR/ADDITION(Prev. Sanitatio Permit# --------------------------- - i ._i --------------------------- Septic Tank (Specify Requirements) -------- --------------------------------------------------------------------------------------------- Disposal: Field (Specify Requirements) -------------------------------•---------------------------------------------------------------------------------------------------- I ----------------- --------------- ------------------ ----------------------------- -------------------------------- ------ ----------- ----------- -------- --------- I --- ----------------------------------------------------------------------------------------- - ------------------------------------ - " (Draw 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 San 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: a f "l certify that in the performance.of the work-for which this permit is issued, 1 shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." -------- Owner Signed ------- , f i r ` ' / ------------------------------- - Title '3 (If other than owner_+, r. k FORDEPARTMENT USE ONLY APPLICATION ACCEPTED BY ` ' ` ----------------------------------- DATE ----- t a� DATE ----------------------------------- - i BUILDING PERMIT ISSUED ___------- - --- ---------------------- ADDITIONAL COMMENTS ------- .li _d = - ------ ---------- --- i ----- ---------------------- - w -- �._ ___ -- - - ----�---.Date -- --- - -- --------- --- ----- ---- Final Inspection b _.._�-�- ------------------------ --�--------------- - - - - - l s SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M -