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i F(UR OFFICE USE: t APPLICATION FOR" SAI ITATION`PERMIT I - Permit No.•--- =Z ---� - (Compl"ete"in Triplicate)' �"' -------- ---------------------------------- ----------- . ; Date Issued _.Z�"��:.�"�/ ---------------------------------- -------------------- This Permit Expires 1 Yeaf Prom Date Issued t. Application is hereby made to the San Joaquin Local Health District for a permit to construct and Inst II a the work herein described. This application is made.in compliance with County Ordinance No. 5.49 and existing Rules and Regulations: o ;G '�4 L,)&f JOB ADDRESS/LOCATION _ _ - }� -- CENSUS TRACT; -------------- s I ' Owner's Name ------ �-----�--t-�=cz_�� - ---------------•------------: ------------=----- ------------- --Phone ------ Address ..------- ---------- 3 r z -----g-��.�i----leiA �f--------------------------------- City --- ------------P-h---o-n--e-----t- -------r-----------J-!- ----- �Contractor's Name . R --------.License # -!S-5----- Installation will serve: ; Residence [Apartment House-F-1 Commercial❑Trailer Court i❑ Motel ❑Other -------------------------------------------- Number of living units:----a<____}_ Number of bedrooms _2 ---Garbage Grinder __ Lot Size __ _-tel a_;I___________________ - } Y r�� ----�------- Private ❑ Water Supply: Public System and name _ _ _ --- - --- ---------------- - Character of soil to a depth of 3 feet. + 5and'❑ Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam:❑ Hardpan ❑ Adobe <11 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.)i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feetX PACKAGE TREATMENT f SEPTIC TANK . Size------- /yf•�'" Liquid Depth ___,Z__f2 _____.,__._ rn} capacity i_(.L-a-V------- Type - c4et - MateriaiCx2-t•,�_ _ t No. Compartments ------ _ Distance to nearest: Well - '----'----•-•------•Foundation _ !a!`____________ Prop- Line --------- LEACHING LINE No, of Lines'-------- -------------- Length of each line-------Az.�-------- Total Lengt�;F__1 ---------•-- nn r! D' Boz ,,�]�_ - Type Filter Material -d-�-----Depth Filter Material _------ ______ __ 1 Distancelto nearest: Well ----- - Foundation ____�4-'�___________ Property Line- .--------------------- SEEPAGE PIT [ Depth Z-- -------- Diameter 3�_"---- Numberk Yes No ❑ I _ 4 1 ` Wafier;Table Depth - __�_.� � RoCS'ize /� � - -Distance to nearest: Weli -----------------------------------------Fo . :---� `---- Prop. Line -------•---.---.--.-•- I • ; REPAIR/ADDITION(Prev. Sanitation Permit s# ------------------------------'-------____-- Date ------------------------------•- ) !: Septic Tank (Specify Requirements} - _ '= - ---------_. Disposal Field (Specify Requirements) -----=-------------------- ------ ------------------------------- ----- --------------- -----_ --- ----------------------------------------------------- ----- -'-------------- -------------------------------- ----------------------------- , (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared; this application aedb that the work will be done in accordance with San Joaquin County Ordinances, State Laws, and 'Ruies and Regulations of the San Joaquin Local Health District.`Home owner or liven-- sed agents signature certifies the following: 3 "I''certify that in the performance of the work,for which this permit is issued, I shall not employ any Gerson in such manner as,to become subject to Workman's Compensation laws of California."- r t � Signed , .. B - �C!-.0 ?----`---- Title ----(?.,- ;------ Y ----------- G'�� {If other than own r I i FOR DEPARTMENT USE ONLY / 1 i DATE . _ APPLICATION ACCEPTED BY _ __ ------- --------- --""" BUILDING PERMIT ISSUED - I------ - ----- DATE ------- ------------ ---- - ADDITIONALCOMMENTS ------------------- ---------------------------= - -------------------------------------------------------------------------------------------- ------------ ---------- --------------------------- -- - ------------ ---------- j '� i ------------------------------------- -----------------�- -- -- --- - ---- t:: - 7 - --------------------------------"- - - - --------- - t r -------------------------------------------- - - ---------- -- - '------- Final Inspection by: ----------------------- --------------------Da a ---- ----- SAN OAQUIN LOCAL HEALTH DISTRICT 441 t E. H. 9 1-'68 Rev. 5M.