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(Complote In Triplicate) Permit No. ................. A _ This Pormlt Expires 1 Year From Date Issued 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 County Ordinance o. 49 andlexIsting Rules and Rogulatlons: JOB ADDRESS/LOCATION ................ ra .%L........I4 ........CENSUS TRACi ................ . ....... ...... ... Owner's Name .......... ........................................ ...................................Phone ...c�r� ..�` . Address .......................5"09/?ng.............,._ CI 51Z.a ' ................................ .. . Contractor's Name ....... d ..('.U..L L .......................................License #�a� SJ a. Phone Installation will serve: Residence❑ Apartment HousaQ Commercial OTraller Court R Motel ❑Other ............................................ igC� Number of living units:............ Number of bedrooms ------....Garbage Grinder ............ Lot Size ... ............. ................... .:. Water Supply: Public System and name .. -.. .. . ..................._. .... .-----...-- .. ....... ..................Prlvatellu Character of soil to a depth of 3 feet: Sand❑ Slit O Clay ❑ Pedt 0 Sandy Loam Clay Loam ❑ Hardpan ❑ Adobe ❑ FUI MaterlalL....i....'..'If Yes.type ............... ....:....... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is.available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK[ ] Size.............................. i.............. Liquid Depth ..........................� Capacity .................... Type .................... Material...................... No. Compartments ..................... O Distance to nearest: Well ....................................Foundation ...................... Prop. Line ..........._......... LEACHING UNE [ ] No. of Lines ............ Length of each line........... Total Length :...........................E 'D' Box ............ Type Filter Material ....................Depth Filter Material ....`..:::......................L.... Distance to nearest: Well ...........,....++.::....... Foundation ...:.................... Property Line ........................ SEEPAGE PIT [ [ Depth .................... Diu meter '..-............. Number ........... .. !' Rock Filled Yes ❑ No Q Water Table Depth .......................'. Rock Size ......�'r................:...... Distance to nearest: Well ........................................Foundation ..................... Prop. Line ........._........... REPAIR/ADDITION(Prov. Sanitation Permit# ....................i.l..................... pate ............. S.q.....�..�) Septic Tank (Specify Requirements) .......... �A�Pl. Z?.......�.`...�..... ..... :c-3 >....._..._.........................._........_................. Disposal Fiela (Specify Requirements) ,/. 1L.rC.7.�!k.... ... ............. .... 4 r ............................... 6- .... .._� ... . ........... ... _.... .. _ ... . .......................... ................................. ....--.-----.---....---.......----....---....---. . ....................... (Draw existing and required addition on reverse side) I hereby certify that 1 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 performance of the work for which Ihis'permit is Issued, I shall not employ any person In such manner as to become subject W kman' mpe talion laws of�California." Signed ....y.Z-- ...... .....Gcs......................................... Owner By . .._....-........................................................t........... .......... Title ............................................. ........... .........:................. (If other than owner) FO EPA_RTMENT USE ONLY APPLICATION ACCEPTED BY ..................... ... .. ... DATE ........... : BUILDING PERMIT ISSUED ..................................................... ........................................:.........DATE ............:.............................. ADDITIONALCOMMENTS ....................................... ............................................. ....................................................................................................................................................................i.-................................. .....................................-...................................... ..................................................................................................................... .. ........................................................ .... Final Inspection by; ......................�%tI ..... . .. _. ...... Date :...�c.�---.�_�.�.�...-.._... EH 13 2h 1-68 iiev. 5m SAN JOA=114 HEALTH DISTRICT 8/7h 3M