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�, _ _• .^- '.� crv��rvry wn unrnr„rrvry rcnr��n _ -- ...._..---- -- .. (Complete in Triplicate) Permit No. ............ ------------ This Permit Expires 1 Year From Date Issued Dare Issued 13. .' r 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 No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION /L'jrjLLIJGF _ :/ ._(�._.�qlt---Q�q-0/ :/f-f-/,--CENSUS TRACT ......._... Owner's Name .._.. �. =�3 ��.. -�C.&=&P!?........ -------------Phone Address _1471---- < e- y- 4., !----y- . i ButES..C�lJ�1.-. City ✓9fQf2------------------------------------------- Contractor's Name ... f1/ 0 - 4Q.F�j----------------- ----------.....License # ------ .............. Phone ----- ....................... Installation will serve: Residence ❑Apartment House❑ Commercial ❑Trailer Court / MoteVP Other ......................... Number of livingunits:.... Number of bedrooms .(x Garba a Grinder .-... � .---- 9 /VQ-- Lot Size�_2.._Gl4..f.=AR. -------------------- Water - --- - Water Supply: Public System and name .._..-----------------------------------------_...................... ..... - ---------...........Private,( r, Character of soil to a depth of 3feet: Sand Sail? Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe❑ Fill Material ............ If yes,type ..._------------------__. f ` (PI'ot plan, showing size mf:lot, location of system in relation o ; ejls, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted Ifpublic sewer is available within 200 feet,) PACKAGE TREATMENT 11; SEPTIC TANK Q ) Size..--- .......... .._..... Liquid Depth .... Capacity --------- ----- Type ......-.-....j------- Material.----------- -----_.. No. Compartments: ---------....... .-... (, Distance to nearest: Well .___-_-= ---------------_-------Foundation ..............-------- Prop. Line ----- � LEACHING LINE [ ) No. of Lines ------------ -------- Length of each line._.... Total Length _........................... 'D' Box ------------ Type Filter Material _-----------------Depth Filter Material ...................................----------- Distance to nearest: Well --- ---. .......... Foundation ------------------------ Property Line ................... t SEEPAGE PIT [ ) Depth ..... Diameter ................ Number ........_...... ----- Rock Filled Yes ❑ No ❑ Water Table Depth -------- .......................................Rock Size .......................... Distance to nearest: Well ..---------------------------- ...-_...Foundation ............. Prop. Line REPAIR/ADDITION(Prey. Sanitation Permit# .........__............................... Date .-................................I Septic Tank (Specify Requirements) - ..................... ... -------------------------------. . ......... - - - - - - r - Disposal Field (Specify Requirements) .....-Q.-I? .......1-L� .._.� ----------- .. --.-__----`----------------------- -----------..--------------------------- (Draw existing and required addition on reverse side) I hereby certify that I }lave 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 this permit is issued, I shall not employ any person in such manner as to become subject to Workmon's Compensation laws of California.” Signed ---- .._..----------- •�-------------- -------*--:�� •--------- -- Owner By .__...- --- - �C.17.-. - /[ Title .. (If other than owner) FOR DEPARTMEENT USE NLY APPLICATION ACCEPTED BY .. - - --�' - tom" `. � .............................................. DATE ._../Z�4� .Ce..I......------. BUILDING PERMIT ISSUED .........__...- - ------------------- ----------- -. ------------...------.......-----.....DATE .-------------_-------- ............... .. ADDITIONAL COMMENTS _._......_. ---- . 5 - . t'y= ... ..... . . -------------------- - -- - -•--•- --- ---- --...-..... --_--------- ------••--------- . . . -----.....------- 6. Final Inspection by: . - - -- ...... ..... -- ....... . ....... . - . . .._........Date _.... .". .51 .W......------ SAN JOAQUIN LOCAL HEALTH DISTRICT 6. E. H. 9 1•'68 Rev. 5M