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........... Permit No. .7.... :?/ � (Complete in Triplicate) *.Wos? .��+.........�.r.......... ��....... Date Issued . ............... 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 compliancewithCounty Ordinance No. 549 a existing Rules and Regulations, JOB ADDRESS/IOCAT ...1 lG .��t� +... ......CENSUS TRACT .......................... 1 .... ..................I. . ...a. M. Owner's Nama ....... ............... .. .. . .............. . ...... ..Phone Address .__......... .... �... _:tea!~...�'L -4 .--........... CIN . � ................... Contractor's Name ....License # Phone,�Ar installation will server Residence Apartment House❑ Commercial ❑Troller Court ❑ Motel ❑Other .. ......_...... . ...... ........._ Number of living units: Number Number of bedrooms -..._.Garbage Grinder .-4e4-'.. Lot Size ._,>ZJr.... 5 ...... Water Supply: Public System and name ....jLLi�aGrc� t t. ? ..................................................Privoteok- Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Q Clay Loom ❑ T� Hardpan Adobe ❑ Fill Material ............ 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 INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) N, 1 PACKAGE TREATMENT SEPTIC TANKj' Size.. r ( ] K I— — �.Z....... .. Liquid Depth ...&I............... I 4 t Capacity/�G 2 !. +.S� Type . MaterialC .. . . . o. Compartments Distance to nearest: Well ... .. �l....................... Foundation.,lB............. Prop. Liras .... LEACHING LINE No. of Lines --------------- Length of ch line-...l�JL1... `.... Total LengthI 'D' Box . .--- Type Filter Material . . ,....Deph` Filter Material ...40 ................Distance to nearst: Well :. -0../..... ... Foundation .. ��.............. Property line ..sS...........SEEPAGE PIT (�c Depth a °:r........ Diameter � ...... - Number ....... .................Rock• Filled Yes ,* NoWater Table Depth --...✓...�..f.........- .......Rock Size -.c `��......-. ............_Distance to nearosf: Wall � .. . . ......Foundation --(............. Prop. floe ....�.._..._REPAIR/ADDITION(Prey. Sanitation Permit# .....__................................... Date ..................................Septic Tank (Specify Requirements) .................................._...._............................_..............--•........................._....._........Disposal Fielo (Specify Requirements) ...................................._....._.................. .................._............................ .............. ...................... ............................................................._............................................................................................ (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 Distrid. Home owner or Ran- sed agents signature certifies the following: "1 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 Workman's Compensation laws of California." Signed .... ... yy . .. ......................... . .......... ....................... ...... Owner � _ V /v7 BY ... . ... ."•• ... .................... Title ....4 ._.... . ...... .. .............................. (If other than owned of /1___/7/If6i11EPARTMENT USE ONLY APPLICATION ACCEPTED BY-... ... k ... .......... ......................._:............................... DATE .. ..,. .!�i} l.......'.' BUILDINGPERMIT ISSUED ....... . ... ... . .. .. ............................... .............................................DATE. ........................................... A C�ITI AL .. . ...................... ... ............. ..................... ............... ........ COMMIE ,....... ..................... ......... ....." .. ........... ....... ----------.................. .............................. .........��.. )) Final Inspection bys ......... ..... . ..........................................................Dale . ... . .y,//7�_... _....... EH 13 2h 1-6f1 JOA IN LOCAL HEALTH DISTRICT 8/7h 3M