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------- / ------ 1tJ{rl rVK bANIYATiON PERMIT (Complete In Triplicafej Permit No. --......_........... _-------------------------------- f- ......................................................... Xlris Perms#Expires 1 Rear loom Dai*Issysd 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 with Count Ordinance N Y o. 619 and existing :-hand Regulations- JOB ADDRESS/LOCATION dr. !TGrI�..CENSU' Owner's Name ..- t Address .._.. 4.AL _.._ •---- ......Phone ......................... .. --... 14 Contractor's Name ----�,�G�- �. �pA�!�- •-•---.__._.lice se . . . •--•----•-------------- n # �� 1�...... Ph -----•-----• � ane .1�.-l ��s�•��>�.._. Installation will serve: Residence p Apartment House 0 Commercial t]Trailer Court 0 Motel Other..... k� �-I-•---•.................. Number of living. units:-- � � -_-�..•.. Number of bedrooms -. Garbage Grinder. A/c!.. lot Size - .............. Water Supply-. Public System and name ............................ ....................................................Private.] Character of soil to a depth of 3 feet: Sand 19 Silt 0 Clay ❑ Peat 0 Sandy Loam 0 Clay Laam [3 .Hardpan 0 Adobe Fill Material ..........._ ty D !f yes, pe............... ...... _ (Plat plan, showing size of lot, Ioc ation of system in relation to wells, buildings, etc. must be placed on reverse side. NEW IN--- - TlON: (No septic tank or seepage pit permitted if public sewer is available;within 200 feet) PACKAGE TREATMENT .[ } SEPTIC TANK[ Size........ ......................................... Liquid: Depth �. Capacity --�--•---- � � ............................ ;� ----•--•-- Type ------•----------_ Material_.:..........:........ No. Compartments ...................... Distance,to nearest: Well .....:..Foundation _..-•-------•-•-----• ..._.. Prop. line . LEACHING LINE [ No. of Lines .------------------------ Leno of each line.--•........................ Total length 'D' Box T filter Material _.Depth Filter Materiot " ype: ............... Distance to nearest; Well Foundation _..... _ .- SEEPAGE PIT � � ne th . Property Line ------ ••----....... , .. -- p .....- ----•• 'Diameter ---------4;...-, Number Q Rock Filled Yes No Water Table Depth --------- ....-.................................Rock Size ---....... Distance to'nearest- Well .................... foundation -•--•---------- -Prop.---- Line . REPAIR/ADDITION#Prov. Sanitation Permit# _._....__.•________________•- Date I ............................... ( Tank Tan Septic (Specify pecify Requirements -•--:--�� .,� "G-� �� Disposal Field (Specify Requirer ents) ----:--:-- - �iu_e-.................................. ------------------- =- - :._ = . __.------- •----=---- •-.------ -} . (Draw existing and requirecl.'addition on reverse side) ! hereby certify that t,)rave preparecl this application and that the work will be done in accordance with Son Joaquin County Ordinances, state laws, and: Rules and Regulations of the San Joaquin Local Hoalth;DisIdd. Home owner or licen- s4 agents signature certifies the fo!lawing: "I certify that in the performance of the work for which this permit is issued, l shall not employ any person In such manner as to become subject to Workman's Compensation laws of California.,, Signed.._----- 4ownerl_ Owner...--------••------- • ---- BY ------•-- Tit)----------------•--------- - ------ (I other than -. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------.... ------ ---. DATE .._..... -�.l BUILDING PERMIT ISSUED .-- -_.... •--= . ADDITIONAL COMMENTS ---•----"---_--•---- ----•--•...:•_•------.....- -------DATE _.._------ ---------_-1- ----- ........--•-----------------�-- . -------------------.-------------------------------••--------•-•--------------- ------•-------- --- .... -•------------ . Finanlnspection by: _____-_••-----_-• Date _...-- , EH i3 2t 1-613 Rev. % t SAN .IOAQUIN, LOCAL HEALTH DISTRICT 8/7h 3M Co