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FOR OFFICE USE: FOR OFFICE USE: ,. APPLICATION FOR SA.,,�T�=N PERMIT- �� « Permit No- --------------------- r (Complete in Triplicate) --------------------- ---- ------------- Date Issued- This Permit Expires I Year From Date Issued ! Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in complionce�with County Ordinance No. 549 and existing Rules and Regulations, T -- - TRACT-----.-------- ---------- JOB ADDRESS/LOCATION -- ---- 1 � - ' T71 )-L _-- CENSUS Phone- City- Owner's Name.-- ------- .�---�� - - � ----- ---- --------'-------------------------------------. - --------- .-- r �f �-` i 1 "�1 jam-G' ---------- p / Zi - Address- ---- - --- .-- - - -- . -- _ h C ty Co tractor's Name--':- - _4-- ---� -�.....��---- -_- -. h 'License g7. .-- Phone installationwill"serve: Residen a Y`"A artment House.❑ Commercial ❑ Trailer Court ❑ '{�,dl ;..�.. {. l . .. - .... �,.� � �� i-.......,Motel ❑- Other- _./.�`��-L��-L -`-� - -- - ------ " - _ ge Grinder-.___-- -;--Lot Size______ __ - --- ---------- -------- Number of.living units:,;--- ------Numberof bedrooms- _------_Garba 'i vKt - ---- ------ --------------------------Private Water Supply: Public System.'and name----------- - - Character of soil to a de `4-3Zt—Sand ❑ .Silt❑ Clay ❑ Peat ❑ Sandy Loam�% Clay Loam ❑ - :Hardpan El Adobe❑ Fill Material._.- ----If yes, tYPe---=------_- f. : � •- e. oJC { (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) J NEW INSTALLATION: (No septic tank`or seepage ,pit permitted if public sewer is available v✓ithin 200 feet,) Size- / ! ----Liquid Depth.-__"a---T- - PACKAGE TREATMENT;. '( ] SEPTIC TANK`V] ' t ' } Capacityl� Yp -e`G No. Compartments--------:�--- __- ------- Distance:to.nearest: Well-e-.. _----- s--Material Fo dation. --= -------Prop. Line-._----�J - --------- f r�- -Length of each fine._ --- '- -- ------------ =-_Total_Length ------ T� LEACHING LINE j ] „ No. of Lines- o .� i :. 9 i ' e th Filter Material-.,_ D' Box Type Filter Material-�� p � f - Distance'to nearest: a-- Foundations- ------ --- Property Line --- i �,. Y N < Depth = ---Diameter---- -------=-- Number- ----------------- ------------------ -------------- ___.Roc --- 5EEPAGE PIT [ 1 p --" R Rock � c iz i = ---- o ------------ Filled es. Water Table Depth- -- ---- ------=-------- . Lrne Distance to nearest: Well-- _--- -------------- ----- -- �-'F oundation-- ----------------------- op - ------- -- -------- -- - I '- :...r• ;.-...+.� ....ate" f REPAIR/ADDITION (Pr,.ev Sanitation Permit#-; -- ----- --- ----- --,___ ---.Date ---. :------------- - . } i Tank (5pecify Requirenentsl_- �"-- ;;- --• - --- ----------------------- Septic -- --- - ------ 1 .. ._ -- --- Disposal Field {Specify Requirements --- ; i ( ' ----- --- ---- --- ------------------------------------------ ------------------ -- ---- . - -- :_ :�� Vz �-- --- --- ----------------- _ I lam ' t (Draw existing-bnd required additionofi reverse side} I hereby certify that %vave prepared this application-and-that-the-work wil ,be done-in -accordance with San Joaquin County I Ordinances,1 State Laws, and 'R les and Regulations o�he 'San Jdaqu'in„lL�col Health District. Home owner or licensed agents i signature certifies the}following. "I certify that in the"perforinarke of the.work for h h this permit is issued, I shall not employ any person in suc manner as to become lsub' to orkm Comp rpsation;.,laws of California." 'U / Signed-- --- E W s i--- _ .Owner - --------------------i ,: = ----- -Ti e -------- ------------------- BY-1 l: -- t " (If other than:owner) _ w -FOR-DEPARTMENT-USE-ONLY 4 C ={' ` ,._4 ------------`- DATE. APPLICATION ACCEPTED. BY-;-__--- ----- --- - 3 „ + DIVISION OF LAND NUMBER.: - -------------------------DATE---- ----------=-- ----- ------- - - -- - --------------- ----------------- --=-------- ----- ADDITIONAL COMM _-- --- r --------- ---------------- - -------- . - - ---------------------------------------------------------. 3----------------- - ------ ------------- ---------------- .-. ----------------------- -----.-------- , -- -- ------ ---- - t ---------------------------------------------------- ---� D--------------------------------- n to - --------- ti Final Inspection.b ----------------------- ------------------------------- _ � by;*i ~----------------- --- ----- F85 2i .7176 3M ' EH l3 24 SAN JOAQUI LOCAL HEALTH DISTRICT e k