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t ' I FCT OFFICE USE: ,� APPLICATION FOi vk. rwiiON- PERMIT -7 ........................... ...."- Permit No. (Complete in Triplicate) _..................'--"' '-- " ........... - - Date Issued ff.- -:2.1 --- -------........._._......................... This Permit Expires 1 Year From Date Issued 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 compliance wiitth, County Ordinance No. 549Jand existing Rules and Regulations: JOB ADDRESS/LOCATION ........ .-1�Z'� T........!!e.-i.Yif,11 'Art? . .................. ....CENSUS TRACT ` ......... Owner's Name .....------IVAIV.l._...i -...� -- Phone .........-"---......--'-"--"•--- Address ----------'---j---�-!7 s"y..'....yf...1:Cr. ------Aw...,-- City .,A-V'R_.----.......----..._......... -'--'---'------------'------ Contractor's Name ------------------------............... ...' '• '------.License # ..----- ---------.. . Phone _ -- .. ' ... . ........... Installation will serve: Residence Apartment House ❑ Commercial: Trailer Court 1 Motel ❑ Other.......------------ ........................ Number of living units: Number of bedrooms ...Garbage Grinder .... .. Lot Size -s-441n.............................. Water Supply: Public System and name .........................................................-'-•-"......--.............-----.-.....----'----Private, . 1 Character of soil to a depth of 3 feet: Sand.0 . .Silt-0 - Cloy ❑ Pea/t,[3 Sandy-Loam ❑ Cloy Loom E]Hardpan ❑ Adobe Efiill M le IaI . ._ If yes,type............................ ' (Plot plan, showing size of lot, location of system in i ti wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit d if public sewer is available within 200 feet,) K3 PACKAGE TREATMENT [ ] SEPTIC TANK Size-y/!` -' -- --------------- Liquid Depth ... Capacity .,!Z-6�.-_. T P ------_-. (.C(PWaferial...�t!P"�e No. Compartments -............ .. Distance to nearest: ..ArA ........................Foundation ..Id.f........- Prop. Lina ...s' �.... LEACHING LINE [� No. of Lines --. _J� . ---- __ Length of each line Total 9 - D... .... Length ��' ....... ...Depth Filler Material __L.Q_'�_............. 'D' Box -.:.".__. a Filter Material �.'Jr----- .............. . D' nce to a est: Well ..._s Q.'-..__...- Foundation ---- - ---------- Property Line _-x r*.._._-------- M SEEPAGE PIT ea h ..-_ . .._..- Diameter ;Fa -...-.- Number ---�".-_............... Rock Filled Yes. No (] © Rock Size . .- ...- - ter To I epth .-../...� --- '- ._.'--'-------"----- '�' - �' -'------ istance o nearest: Well _._.A ........................Foundation .. b.--------- Prop. Line . ..............._ REPAIR/ADDITION(Prev. anitati n Permit# ............................................ Date ---........--........-..-.....-.--) SepticTank (Specify Re uire nts) -------.._.....----'------------------------------._---------....-'-'------------------------_.•_-------------------- Dii Disposal Field ISpeci a irements) ---------------- ------------------ -- ' ' - ' ' " - - ... p fY (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: i certify that in the perform nca of the work for which this permit Is issued, I shall not employ any person in such manner as to become subiect to wa m 's Co ensation laws of California." Signed ------- - ---------------- ------------ ........... Owner By ..... - . . .............................. '- ................................... - Title - ---- ----------------- . -------............................. (If other than owner) FOR .DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...1-�2.......--'-- n'-=�'.......-'---'-..... --------------------'------------. DATE .6-.�r BUILDING PERMIT ISSUED ....---- ' -- " DATE ADDITIONAL COMMENTS ./.O-.L }T-�/--------- -�'�c.......x�kf1ZP _ .....�. . .... pf Q:x r,� -_* _� ��- :;"x--'----- p- ` -'---'. ................... ----------.---.-----.--.-.-----.--.- " . ' -' t V - - -- - -- - - .._.. ..._ .-. _ - - -'-' - - .............. ....... .... _ - -- Final Inspection by: -- -' --------'-........- `�' Date --' - SAN JOAQUIN LOCAL HEALTH DISTRICT A/ ee� E. H. 9 1-'68 Rev. 5M 1