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AFRKA V /E'er MWASION ROM pwms Poo. aa (Complete in Triplicate) _. ............................. y .... .... ................ .............................. This Permit Expirvs 1 Year From Date Issued Dote Issued .1�.��1.' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work heroin described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: e JOB ADDRESS/LOCATIONa/704r-/. ..CENSUS TRACT ................»...»... Owner's Name .. ...... ............Phone .................»»... ....»... Address --- .-R-17.0.l� .. ... . ......... .......... City _....._..... .. .. ..................... ».._._. • ,.../ . 10 Contractor's Name ........ .fu,!t..�. ,Liamse#��3�....... Phone ......................._.».. Installation will serve: Residence Apartment House❑ Cowmercial ❑Trailer Court ❑ Motel ❑Other............................................ Number of living units:......... Number of bedrooms ....Garbage Grinder .... lot Size .........._. T Water Supply: Public System and name .................................»..........................................................................Private,' Character of soil too depth of 3 ftet: Sand❑ SII:❑ Clay ❑ Peat❑ Sandy loam ❑ Clay loam Hardpan❑ Adobe ❑ Fill Material............ If yes,type............................ �►9 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) v NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) Q PACKAGE TREATMENT ( ] SEPTIC TANK( ] Size..................._........................... liquid Depth ....... a1 Capacity ... .............. Type ................ .. Motertal...................... 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 Pro Line .......»............... ........................ party ...........»........... SEEPAGE IIT [ ] Depth Diameter ...........»... Number ............... ......_... Rock Filled Yes ❑ No ❑ Water Table Depth ...............»......_......................Rock Size ............................... nlstance to nearest: Well ..................»................ Foundation .................... Prop. Line ......... REPAIR/ADDITiOtI(Pre,/. Sanitation Permit#............................................ Date ....»......»..._....»..».....) SepticTank (Specify Requirements) .........................................................................................................,........_................ DisposalF,1'� R kern nts) ....................................... ..........................................»........................................_... .. ................. ....... ........... ....... ............. ... ,iA ( awexisting and addition on reverse side) X I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin L County Ordinances, State Laws, and Rules and Regukr4ons of the Son Joaquin Local Health District. Herne owner K lioso- sed agents signature certifies the followings "I certify that In the performance of the work for which this permit Is Issued, I shall not employ any person In such moaner as to becomr, to law "s Compensation las of California." Signed ........ j] ... ...................................Owner By ............... Y ... .. ..... .._ ................... Title .... � +.... (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ............................................................. DATE ............».. BUILDINGPEPMIT ISSUED .............. ............... ...........................................................................DATE .......................................— ADDITIONALCOMMENTS.................. ............................................»..................................................................»......................... I Final Inspection .bye.................:.... ..... u .......................................... ... . ...........Date�/ .:sn�► .. I SAN JOAQUIN LOCAL HEALTH DISTRICI E. H. 9 1•'68 Rev. 5M