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FOR OFFICE USE: APPLICATIOWFORIMNITATION PERMIT A/f/�-L<------------------//. ^ '070 (complete in Triplicate} Permit No: _._. �� - �- -�, _:z:zn -. 3 6- ,� ;. Date Issued _l�__2=2L. ----------------------_--------------.------------- ---- 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 icompliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION �.1W141 --- ------------------------------- CENSUS TRACT -------------- -----. .✓ Owner's Name ----- - —--_- r = Phone ---------- `` ____.�ir'�.eV4e7 City .J . �e/ : Address _._�(,1 �-- ----- - ------- Contractor's Name ____ %% C _ _fi _-ft --------.License # Z'_��JZS--_ Phone _ �✓ Q _ Installation will serve: ResidenceXApartment House❑ Commercial :❑Trailer Court i❑ Motel ❑Other ------------------------ ------------------- Number of living units..--/------ Number of bedrooms -_�_Z______-Garbage Grinder ------------ Lot Size --------------- Water Supply: Public System and nam_e ----------------------------------------------•---------------------------------------------------------------Privatex Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam .C] Clay Loam ❑ Hardpan ❑ Adobe Fill Material ------------ If yes,type ------------________________ " (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.]r NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} PACKAGE TREATMENT [ ] SEPTIC TANK- ] Size------------------------------------------------ Liquid Depth ------------------------_ x fi[-s Capacity ----------- -------- Type -------------------- Material----------------------- No. Compartments ------ --------------- Distance ------ ----Distance to nearest:' Well __________________________________Foundation ---------------------- Prop. Line -----------_ �,. LEACHING LINE [ ] No. of Lines _______l_______________ Length of each line----1D__Q------------- Total Length --Z lqtq D' Box �:J--- Type Filter Material _� -_V-____Depth Filter Materia! _-__-/ ______________ __ y•---•---•- Distance to nearest: Well ------75---------- Foundation ...le2------------ Property Line 7.............. SEEPAGE PIT [ ] Depth ___crV_S ------- Diameter - ----- Number ------------___ Rock Filled Yes No ,0 Rock Size __cp2 X_r�------ 011Y ____ �X� Water Table Depth -------- �Z----------el---------------- - j Distance to nearest: Well --- L ________________________Foundation ___ --------- Prop. Line -----_.___...__.. I REPAIR/ADDITION(Prev. Sanitation Permit# -------..----------------------------------- Date -----------------•.---------------f SepticTank (Specify Requirements) ---------------------------------------------------------------------------------- ------------------ --------.<.--------------------------- Disposal Field {Specify Requirements) _....._ _ __________ __ __ __ ,f -�--� -------- ---- -- --- - - - -- ---------- --- (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin. County Ordinances, State Laws, and Mules 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 nwork for which this permit is issued, I shall not employ any person in such manner as to becom ect to Workmen's Compensation laws of California." Signed - -- ------------ -- ------ -------- Owner By ------------------------------------------ - - ------- ------- Title ---- --------- ------------------ JIf other than owner FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�- - - ---- ------------------------------------------ -------------------------------- DATE ---�} - - -f1J~-------------• --- BUILDING PERMIT ISSUED --- -------------------------- -----------------------=--------------DATE --- ----- - ADDITIONAL COMMENTS -- --------------------------------------------------------- - ------------------------------------------------ --------------------------- --------------------------------- - ---------------------------------------------------------- -- __- -- --------- ----------------------------------------`-------------------- ------------ ----- -- ------- ----------------- ------ -- - Final Inspection by: 1�� ------------------ ------------------------------.Date ----- SA�UIN L CAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M