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FOR OFFICE USE: APPLICATION "FOR'`tANITAT'IO' N PERMIT k_ Permit No. .7Z---6 --------------------------------------------------------- (Complete in Triplicate) - --------- ------------------I--------------------------------------- Date Issued -(-------7-----7--1-- ;I This Permit Expires I Year From Date Issued ------------------ --------------------- ---------------- i is hereby made to the Xon oaquin Local Health District for a permit to construct and install the work herein described. This application is madelin with County Ordinance No. 549 and existing Rules and Regulations.. JOB ADDRESS/LOCATION ----------------------CENSUS TRACT -------------------------- ,P--- -------- jj Owner's Name ----- —---------------------------------------------------- -------------------Phone-94>213---A�;XOK' V -,A ------------------- City ..... ------------------------ ---------------- Address ------7�/,/ ------------- I-VA-1w I Contractor's Name ----xw......5eyj--- --------------------------z--------License # ----- - ---------------- Phone ------------------------------ Installation will serve.. Re's'idence WIA�Pament House,E] Commercial :E]Trailer Court �El !I Motel F-1 Other -------- ----------------------------------- Number of living units:----/---- Number of bedrooms ______Garbage Grinder ------------ Lot Size Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private 5d-� Character of soil to a depth of 3 feet: Sand'[:] Silt❑ Clay E] Peat E] Sandy Loam WTClay Loam E] Hardpan E] Adobe-E] 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.) \1 i NEW INSTALLATION: (No septic lank or seepage pit permitted if public sewer is available within 200 feet,) I is 10 1,e PACKAGE TREATMENT f I SEPTIC TANK Size--_ tr�'��g-------- Liquid Depth ......v.. ............. N Capacity 140AO'4V----- Type PZ467C Material______________________ No. Compartments -------�—........ Distance to nearest., Well ----_______________Foundation --1-45'-------------- Prop, Line ____-_-•-- LEACHING LINE f No. of Lin Length of each line-------q:.?-It Total Length ------------ Y-&---------- .0 ------------- -- Depth Filter Material -------- ------------------------------ 'D' Box --,/------ Type Filter Material I e I Distance to nearest: Well - ------ Founclatio 1 /--3 ` n _/+-'_______________ Property Line --- ------1-11-------- SEEPAGE PIT Depth- _.__._-I------------- Diameter ---------------- Number --- ------------------------ Rock Filled Yes El No C) Water,Tabl6'Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest. Well _.__-__________________________________Foundation --------------------- Prop. Line ---------------------- REPAIR/ADDITION(PreV.-Scinitation Permit# ------------------------------------------- Date ---------------------------------- SepticTank (Specify Requirements)---------------------------------------------------------------------------------------------------------------------------------------------- Disposal Field (Specify Requirements) --------------------------------------------------------------------------------------------------------------------- --------------- ----------------- ------------------ - ---------------- --J--------------------------------------------------------------------------- ----------------------------------------------------------------- 41 --------------------------- ----------------------------- -------------------------- -------------------------------------------------------------------------------------------------------------- - (Draw existing and required addition on reverse side) I hereby certify that I have prepated this application and that the work Will be done in accordance wish Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son 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 f to WopXrricinY Compensation laws of California." Signed -------- --- -- --------- ----------------------------------- Owner By --------------------- - Title (Ifo .----------- ----- ------------------------------------ ---------------- er than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- ----------------------------------- ----------------------------------- DATE ----------------- BUILDINGPERMIT ISSUED --------------------------------- ---------------- ----------------------------------- ------------------DATE -------------------------------- ---------- ADDITIONALCOMMENTS ---------------------------------------------------L-----------------------------:------------------------------------------------------------*------------------- --------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- --------tz�--- ------ ------------- -------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ------------------- ----- -------------------- . ------------------------------------------------------ -------------------------------------------:------------ ------ Final Inspection by; -------------------------- --------------------------------------------------------------------- Date --- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'b8 Rev. 5M