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.................... ................. �N r{'tt ,F:,; :vN PERMIT Permit . . I....... . (Complete in Triplicate) No. ..................... ThisPermit Expires 1 Year From Date Issued Date Issued ..3J..... ._). 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 Regulations, l� JOB ADDRESS/LOCATION ... f`' F- Gv n .....�:......... ... ..........................CENSUS TRACT ................. Owner's Name ..i' .. �� c�!!.f}/2��:........../.1.. .. ................................ ..Phone .... Address ...... ...... ...... 1.. �Ciry .... 1-3 .4.. Contractor's Name ..�. -- .�.. :: ........................................ License s j'l. Phone4;--V .......... . ............... Installation will serve: Residence 9 Apartment House 1❑ Commercial QTraller Court 0 Motel []Other................:............. .,......... Number of living units,......../ Number of bedrooms '.a. Garbage Grinder �a -•-•• Lot Size Water Supply: Public System and name - ........................... . .. ......... Character of soil depth of .--...._...................._................... ...........Private to a p 3 feet, Sand t] Silt❑ Clay Cj Peat❑ Sandy Loam C] Clay Loam Hardpan 0 Adobe 0 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 INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 200 feet,j PACKAGE TREATMENT [ ] SEPTIC TANK ] Size................................................. Liquid Depth . . . Compartments Capacity .................... Type .................... Material............. ... .. No. Com ...................... ...................... Distance to nearest: Well ....................................Foundation .................... LEACHING LINE [ ] .............•--........ .. Prop. Line ...............»..... No. of Lines length of each line..._....................... Total length ............................ 'D' Box ............ Type Filter Material ....................Depth Filter Material ........................................... 6 Distance to nearest: Well ........................ Foundation......................... Property Line .................. SEEPAGE PIT [ j Depth .................... Diameter Number . Rock Filled Yes ❑ No I❑ Water Table Depth ................................................Rock Size �i ................................ Distance to nearest: Well ........................................Foundation .................... !s'cta!,tn r�,n!�rv,�,•�t,.. . �... ,.. Prop. LiM ...................... Septic Tank (Specify Requirements) ............ Disposal Field (Specify Requirements) ......... p...... ' ,...L .....................»........»..... ......................................................................................................................................................................................................... . ................................. . . ........................................................ (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 aaerdance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licew sed agents signature certifies the following: "I certify that in the perforipance of the work for which this permit is Issued, I shall net employ any person In such manner as to become sub' ct to ork?m��i's Compensation laws of California." Signed ,�- ----.��. ... .. ............ .. --.....-•---- ................ Owner By -.... .... ........... ........ ..- . Title (If other than owner) F DEPART NT USE ONLY APPLICATION ACCEPTED BY ... _ .. ... DATE . .,.,1..x. 1 BUILDING PERMIT ISSUED ............. .......... ...................... . .................DATE .......................................... ADDITIONAL COMMENTS . "---.. .......................... ...... .. ...................... ...... .................................................. ............. ....... . _ . Final Inspection by: .. ... ... . ..............Date . . .. . . ............. . ....... .... . EH 13 2b 1-68 lay. 11 . .. ............... 5 SAN JOAQUI LOCAL HEALTH DISTRICT 8/7h 3M