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E FOR OFFICE USE: APPLICATION FAD SAWTATION PERMIT / - ----------- --•-------------------- --- Permit No: ------------ (Complete in Triplicate) � --------------------------- ------------------------ ------------------------- -- -------------_----_-------- This Permit Expires 1 Year From Date Ensued Date Issued -67:/--- Application is hereby made to the San Joaquin Local Health District for a permit t construct nd install the a work erein described. This application is made in compliance with County Ordinance No. 5 and existing Rules and Regulations: JOB ADDRESS/LOCATI N .____ -� - _/1? NSUS TRACT -------------------------- f Owner's Name .-- A- ----+UU- �dl 'f Phone ` Address ------------- -- ----- --� -- �� --- - - - �7-�'"-------- -- . itY ------ --- -- - --- - ----- - ----- --- - ----- -•- .� C' Contractor's Name _______ _ _ ____.License # __� t ��one� ---� -/� --�--------------- z Installation will serve: Residence ❑ Apartment House,❑ Commercial'.❑Trailer Court ;0 y i J ' Motel F-1Other --------------------------------------------•- ` Number of living units:--- Numberbedrooms _ � _...Garbage Grinder __ e�>--- Lot Size'-4-P - ------- l _______Private Water Supply: Public System and name -- _�-- - -_ .�_C?_., -�J ---------- --------------------•---•------ E] Character of soil to a depth of 3 feet: Sand Sift❑ I-Clay Peat ❑ Sandy Loam {] FClay Loam :❑ Hardpan Adobe Fill Material -_ �� p ❑ -------- If yes, type ------------------------- (Plot plan, showing size of lot, location of system in 1'relation to wells, buildings, .etc. must be"placed on reverse side.) f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) y PACKAGE TREATMENT [ ] SEPTIC TANK ze____ Xo ________________ Liquid Depth'__l Z_______--_. � N P Capacity/ _ _______._ -_ Typ C.oaf_ Materia -- 1�__v��-G No. Compartments __�--- ...... . (n (Distance to nearest: Wel ______ _ _ ___ _____Foundation _____.___ Prop. Line __ _____________ La LEACHING LINE [ No. of Lines ---�----- __ ____ Length of each line---0_J___r - ----- Total 'Len th � -------- ---------- Z IV 'D' Boxy XI ��.__ Typ r ter Material/�Z-�---------Depth Filter Material _ _____________________________________ Distance t ear t ell ____----- Foundation _ ,¢-__---_----____ Property Line "5_____ _____________ r SEEPAGE PIT ] Depth _ __ __ Diameter _ _---_ Number ----------) ------------ Rock Filled Yes Water To le D h __________ 46�'g------------------------------Rock Size /%��--�-t------- ' 777=----------------- 3 / t Distance t nea est: Well ----------=-----------------------------Foundation h-----------r Prop. L ne ----•.-•-•-_-- REPAIR/ADDITION(Prev. Sanitation a it# ------------------------------------------- Date ----------.------------------.-.--) I , SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ------------------•----- _---------------- ----------- Disposal Field (Specify Requirements) ________________ -`-------------- - .. — --------------�: r: ------ - ------------------------------------- ..................................................... ----------------------- ---------------------------- -------------- -------------------------------------------------------------- ----------------------------------------------------------- t[Draw existing and required addition on reverse side) I hereby certify.that'( 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. Horn"e`bwner or licen- sed ggerts 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 Caiifornia." Signed -- -;---- ---------------------- - ----=,-- --- - ----_-==--------------------- Own r ------- Title ------- wner (If =-------- l (If other t h caner) J i0 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------- ------------------- --- DAVE _. . - - - ']I BUILDING' PERMIT ISSUED __. --------------------------------------------------- ----------------------=--------------DATE ---------------------------------- ----- ADDITIONAL COMMENTS --------- ----------------- -- --------------------------------------` `-- - ------------------- __---------- ------------------ 3 ----------------------------------------------=---------------------- ----- 1 FinalInspection bY- ----- ------------------------------------------------------------------------------ --------------------------------Date ------------ ----------- SAN JOAQUIN LOCAL HEALTH--DISTRICT E. H. 9 1-'b8 Rev. 5M