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FOR OFFICE USE: .......I....................... ................ APPLICATION FOP-t S4VITATION PERMIT 97dV (Complete in Triplicate) Permit No. ..................• 'ie Z1 ........... ...................... This Permit Expires I Year From Onto Issued Do Issued Application is hereby made' to the Son 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. 549 and existing Rules and Regulations- JOB ADDRESS/LOCATION . o S, ........... . ...... ......... ....................CENSUS TRACT ....-.......1�...... Owner's Name tlell.... .........................................Phone &1_23:n131,7:.V... Address Z ... .... . ............... city -- --- ....... .......... ... .. .... .....---•.................. ....License #Q-Y_�?/. Phone Contractor's Name ---------p— �----- litre/...- - Installation will serve-, Residence E] Apartment House q Co,;mmercI1...I Effrailer Court 0 Number of living-units:....... Motel E]Other--------14W:5 .1-.-...Number of bedrooms ............Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ..............•................................................. ...............•---................... .....Private P97 Character of soil to a depth of 3 feet: Sand W Silt 0 Clay 0 Peat[I Sandy Loom [3 Clay Loom ❑ Hardpan El Adobe 0 Fill M6terlal ............ If yes,type ............... ............ 9 (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) I NEW INSTALLATION: NJ septic tank or seepage pit :permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK( ] Size................................ ............ Liquid. Depth ....... ...... Capacity .-............... ... Type .................... Mater' I............. ....... No. Compartments ....................... Ai 00 Distance to nearest: Well -------- .................. .......Found ion ...................... Prop. Line...................... 04 LEACHING LINE Noll. of Lines ------------_---------- Length of e line---.---- .................. Total Length ............................a V 0 B 0 il ox ............ Type Filter Material ..... ..............Dep De Filter Material ........................ ................... Distance to nearest: Well ......... ...... ... Foundatio ---.- ----.--........... Property Line .............—......... 0 SEEPAGE PIT Deo th -----_---------.--- Diameter __- -_-_ Number ............................ Rock Filled Yes ❑ No %A Water Table Depth ------------------------lock Size ------------ ...................L-e-nti- ha0feMterInate............................ Dr I .. .....--------------- --- Foundat 10r ------- -------- Number--- ---------------Distance to nearest: Well ........... ....... .................... oundation ........ Prop. Line ...................... Date REPAIR/ADDITION(Prey. Sanitation Permit# -------- -------- .......... ........ Date ............ .................... .4 Septic Tank (Specify Requirements) -------------- ---------------------------------------- .......I....... ...... ........ ....................... Disposal Field Specify Requirement ------- ;q.dd ------b.......... "A- ..... 1�4 jo,� ........... ------------ .......... 'z. ....Z�_-.eil�----_------- ........................ ----------I----------------------- -----------------I--------------- --------------------............................. --------------- ....... ........................ ............ I hereby certify that I have: (Draw existing and required addition on reverse side) .,,Prepared this application and that the work will be done In accordance with San Joaquin County Ordinances, State Laiws, and Rules and Regulations of the Son Joaquin Local Health,District. Home owner of licen- sed agents signature certifies the following: "I certify that in the performance of the work for"which this permit Is issued, I *hall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ----. : -------- -------------_---- ------- Owner By ---------- --------- .......... (If other than '6wner) .-..-•--- . ------ ----------------------------------- litle ---------- ............. .. ...... ------ ------ --- -FORKPPATMENT USE ONLY APPLICATION ACCEPTED By ....... _11�------------------------------------------------ DATE BUILDING PERMIT ISSUED 1--------------------------- I.............I 'DATE . --------------------------- ..... ADDITIONAL COMMENTS __ ------•-- ---•- ..-- ------------------------------- ------- -------- ----------------- --------------- ---•--------------•-------------------. . ........----------------iM ---•--- ....... ----------------------- -------i�--------------- - ----------------------- --------------------1-1------ -------------1------------------- ... ......... ............................................... ....... - ------ ....... ........-1......------------------------------------------- Final Inspection by. -...... .11 ----�!........................... .............I------- ..............................Date EH 13 2h 1-68 ... .......I.. ... ..... >__� ........ RAW 5M SAN JOAQUIN' LOCAL HEALTH DISTRICT 8/7h 3M