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__---__------------------_ _ ------ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the SaR'Joaquin Local Health District for a permit'it construct and install the work herein described. This application is made in/compliance h County Ordina ce No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION - _-___ \ _ ___.a�� ___..__. _ . CENSUS TRACT --------------.___-_-_-_. _ r Owner's Name ------------- ..(Q. ---------- -------Phone Address ---------- ------------- ' ------- _ _ City --J---------- - - ---------------------•-- Contractor's Name ---------License #lOd-V�___.-_ Phone ------------------------_-_- Installation will serve: e iden atm nt House,❑ Commercial ❑Trailer Court ;❑ ) Motel ❑ Other ---------------------------------•-------- Number of living units: ----- Number of bedrooms ---7-'--Garbage Grinder Lot Size ----- ----- ...... Water Supply: Public System and name _______________________ Private -•----. Character of soil to�de ht 'of 3 feet: �S,c{p t ❑ Silt❑ Clay ❑ Peat❑ 'andy Loam ❑ Clay Loam E]a 6 Hardpan❑ Adobe ❑ Fill Material '___ -___F_ If yes, type ----------------- - (Plot plan, showing-size of-lot, locot rj-o'�'s"� eYnm -it,relation to wells, buildings, etc. must be placed on reverse side.) o NEW INSTALLATION: (No septic Tank or seepage pit permitted u• ac'�-sewer is available within 200 feet,) PACKAGE TREATMENT [ ] PTIC TANK[ ] Size---------------------------- ____ Liquid Depth ___ .___---_-----____- C city - -------- Type ----- -------------- Material_-.------------------- No. Compartments i istance to nearest: Well _--------- ------------------------Foundation ---------------------- Prop. Line _--------.--:._---_-- LEACHING LINE [ No. of Lines ----------- Length--of--eath"lin-e--- '-------_----------_ _ Total Length -_----_-__--___•-_--_-._.._ � f 'D' Box .- _ .. _ Type Filter Material --------------------Depth Filter Material ------------------ to nearest: Well _--.-___-____.___-__- Foundation ------------------------ Property Line ______--_._._.___ SEEPAGE PIT [ ] Depth .... . . ...:...__ Diameter __-_-____---__ Number Filled Yes ❑ No fl Water Table Depth --- -----------------------------Rock Size -----------•------------------- �l Distance to nearest: ............................. ____.-___ _ _ ---------------_----- _..... .._..___._Foundation _________________ _ Prop. Line �\ REPAIR/ADDITION Prev. Sanitation Permit# _,____________ --------------Date ----------------------------------) SepticTank (Sp cify Requirements)'-------- ----------------------•------------------------------------------------------------------------------------ ----------- --------- Disposal Field Specify Requirements) ----- -- -------------------------- ------ d r ------------------ -- -- _ ---- (Draw existing and required add �y -- ------------------------------------ ---- ------ -------- - -- ----- . i#iop ion«reverse side) I hereby certify that I have prepared this application and. t �at�the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and R69platioeisio t,e 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 slect to Workman's Compensation laws of California." Signed `�- 1 NA��--� -- -�--------- 7 -T' ---------- - -b:�_P4.Sf�� Owner BY ---------- ---- -------------------------------•------------------------ Title -----------R/------------ ----------------------- ----------- (If !other than owner) ! FOR DEPARTMENT USE ONLY ----- -------------------------------------------------------------• DATE --------- APPLICATION ACCEPTED BY - - - - ` � BUILDING PERMIT ISSUED-- -DATE ------------ -•-- --------------- ADDITIONAL COMMENT -----------•---------•---------LP J ------- -------------------- r :• ?y •+ ----------------------- -- ----- : --•------------------------------ ---------------------------- -- ----------- ------------ - -------- ----------------- --------------------------------------------------------------------------------------------- - --- Final Inspection by: _- ______________Date ------1O_:-_------__- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M