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Nt'r'LII,.H11vly 'tUK �HlVIIHIIViV t'tKM11 _ •----------•-- ti, , ti _ ti Permit Nola - 5 jf r (Complete in Triplicate) .... This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549 and existing Rules and Regulatipns: JOB ADDRESS/LOCATION :t..__.•.!f .! -- --_--. 1.' /fW ... lV..---L..!` CE S TRACT P---._.....•-_.._.----- Owner's Name AaC.44...; X1"+1- . �..r_. ._.. - --- - --_Phone .................................... Address .. .. . it .... Contractor's Name .G_ ;ir�l>� License gl�c �.lD... Phone ..._.....-•- .... Installation will serve: Residence[Apartment House 0 Commercial❑Trailer Court,j] Motel ❑Other................._......................... Number of living units------------- Number of bedrooms..-.Garbage Grinder ------------ Lot Size 2 .......... Water Supply: Public System and name .................................-_...-_-•-•--•.--------------.-----.-_-------•,-._...._....- .............Private ❑ t. Character of soil too depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam Clay Loam n Hardpan ❑ Adobe D 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,) PACKAGE TREATMENT { ] SEPTIC TANK ] Size-----_-----_----------_....-------........... Liquid Depth .......................... {� Capacity ----- ------- Type ---_-_----------- 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 -170-_CA_.Depth Filter Material .Z.9. Distance to nearest: Well ---..d......_.-.._._ Foundation ._._..............._.._. Property Line ... SEEPAGE PIT [ J Depth Diameter ................ Number ............................ Rock Filled Yes ❑ No ❑ Water Table Depth --------------- ................................Rock Size .----- ................ Distance to nearest: Well _-.....- ------........................Foundation ._...._...... ..... Prop. Line ___-___ .............. REPAIR/ADDITION(Prev. Sanitation Permit# ........_.............. ............._...- Date __--__.__.___.___-._------___----_) Septic Tank (Specify Requirements) - -----------------_-- --- ------- --................-- Disposal Field SpRcify Require ents) C. . ��Y..._ i...... L. l/✓ ..__.. �1 cTYi�'/?'-��r...._.._. ..._-_ -. -- --------AE7, - ----7on to.<--._-. .....evu-1 ------*---------- .......... (Diraw tion reverse side)existingand red 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 District. Home owner or licen- 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 _. .. ---4-••- ................. Owner BY - •- Title -Z ................. . ......... ................ (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B '---... ...................... DATE .... _-- 7.._.... ..__.._..... BUILDING PERMIT ISSUED _.__..._. ------- ._DATE........................................... ADDITIONALCOMMENTS ------------------------------------------------------------ ---- -. ................ ................-••-................=........................... ••------------ -----•••-- - ----- _. --- ----------------------------------------------------------------------•-------- . .. . -- --- ------------------------ ---- --- ----- --- _.... .__ --••---•----•------•---.....•-•-•.............._.... .....-----.........-- _-------- ------------ --------- .......... -•---i -----•--- ---------- . .. ..... ---•-•••-• .........._._.._... Final Inspection b - . . :.-. P y: .. Date ._. ----------- -- $MQ`JQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M