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I FOR OFFICE USE: Oakdale Q2nr.L9fe & pipe Co. FOR OFFICE USE: y PDST OFFICE SOX 13 Permit No...I__�_'a.7.3 ❑AKDALE:, CALIFORNIA 95361 Date issued_ Application is hereby made to the San Joaquin Local Health District for a permit„torconstruct and install the work herein described. ; This application is made in compliance with County Ordi nce No.5--49 and existing`Rules and Regulations:-sem" JOB ADDRESS/LOCATION S.• ------ tz., >--. -1,6 t u .fl-- -- --- CENSUS TRACT.�'S-'°`t e,J--------- I Owner's Name ---- ----- ----- -------- -------- --- ---- ------ ---- ------ ----------------Phone.---------- --- - ----- Address-- 5' ---- --------------------------------------- City- .5 _ 1. -----------Zip�---- - --------------- Contractor's NamePWX-4C ; -------_�- �aT .---- [�i -- ----------------License #_ --S'8G' ------------------------------� Phone Installation will sere: Residence Apartment House E] Commercial ❑ Trailer Court.❑ # c Motel ❑ Other------------------------------ ---------------- 3 ------ ------ I r g Iy 3 ,�c cG ° Number of living un bedrooms--_____-, Garbage Grinde-ry_1>,:�_Lot Size.___.___..__1Z__________ ________,.____:__._.__..______- Water Supply: Public System and risme r.._:�,___._. ------------------ ------- ---------- - rivate Character of soil to Q depth of 3.feet;., Sand E Silt:EajCla - Peat a Sand Loam ClayLoam Hardpan Adobe ❑ -J,* Fill MateriaIf yes, fiype ._______.___._; (Plot plan, showing size of lot, location of systemin relation to wells, buildings, etc.}must be placed on reverse-side.),] NEW INSTALLATION: (No septic tank or seepag p f permitted if public sewer is available within 200 feetj: PACKAGE TREATMENT [ ] i SEPTIC TANK size---------- ` "i_ _______LiquidDepth.__.ti�___________ - - ----------------- -- Capacity__fZ4 d-----:Type-'S k--------- -----------No. Compartments--------------- -------------- e i i _�, Distance to nearest: Well------ 3___. .__'.__._. ______Foundation______---__.____-- -Prop. Line"7�` _..___._______ LEACHING LINE [ ] No. of Lines-------- _----------------- I gr) I ----�--.----:Length of each line.------�'� :-�------------Total Length - ,�-,�0-----'.--------= s 'D' Box-----I-------Type Filter Material_1_ Depth`Nter,Material__ __i<_'__--- -w-_--- --T _ t--- ---------- _ _ Distance;to nearest: Wef!___ Zp _. ,z____._____.Foundation ___��___.__' _ _.__ _____.Propetty Line______7___.__s_______�3.__._ ._,_. 4 SE NT [ ] Deptl ------4.-J-C-Oa r-.------------ Number--- --- ----------- - -- ' Rock Filled Yeses No Water Table Depth---------- ------------=-------------------------------.Rock !Size------t-Y2'"-------------------------------- � _—. Distance to nearest: Well'.-__... ----------________________:Fo'un dation-------1_p-------------Prop, Line........ ______._______. b REPAIR/ADDITION (Prev. Sanitation Permit#_.._ --- �________________________Date__.B-_""_�______� __..__._ ) SepticTank (Specify Requirements)------ ------- _ �5'C`!��_.__ Lf 5- - GAu------------------------------- Disposal -- Disposal Field (Specify RequirementsE�3_4__ ----- ��.i d. --'-----T-aJ_3T+�f( -----1--� ___.--_ _S �`'Z--"-'-----------. a 4. .I [ �-� T __+ _, - `- - --------------- s ---------------------------Z� (Draw e'zisting and required addition on reverse side) f 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 licensed agents F 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 becomect Workman's C p sation laws of California." . Signed-- _. — -- -------- �`.c�...,------------------- -----Owvnw .._Title_.O A>._A�8 ,----:- TTfa_:TA0'.- Y : ' (If other than owner) , OR DEPARTMENT USE ONLY 9 } APPLICATION ACCEPTED BY. ------------------- -------------- -------------------F. �------------._..__DATE / — ----------- may, -- : - ----DATE ---- --------- DIVISION q -------- ADDITIONAL COMMENTS NUMBER R. F ----- K - --------- -----'---=-- _..�'� _. a.r-�f--- . ------- -------------------------- ------- ----------'---------------------------- ---- ----- ------- ------------------------------------------------------------------------------------------------------- ---------------------------------------- - - ---:------=- ----------•---- Final gInspection by:---/- -',—--' --------------- --------------'-------_----------------------- Date--- r. FH 13 24 SAI JOAQUIN LOCAL HEALTH DISTRICT F&5 21677 REV. 7/76 3M IN (_X13 4