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FOR OFFICE USE: -APPLICATION ,Flik 7AA TO& PERMIT ------ ------------------------------------------------- t Permit No. J�=5� . (Complete in Triplicate) t Date Issued ___ -l___� Y 4i- � ---- _---- F This Permit Expires 1 Year From Date Issued r � Application isby a to the San Joaquin Local Health Disfrif_t:for--; a permit to construct and install the work herein des�fT�e hiscii i r co once with County Ordinance No. 549 and. existing Rules and Regulations: JOB AD SSAATION "� /F c� c i - •--k�' fTRAC�---- -�.---- -- Owner's Name s P.4J !V � ---------------------------------- --------------------Phone _'".SV(IzJ� Address -------------lb_iP__10Ca - ------R)7................. Cit Contractor's Name ----- �1..�..r Lr-Gtt/ (�r �/ �.. / _____.License #Q9-�i3,9A -- Phone _PZ3.7_6V Installation will serve: Residence OApartment House❑ Commercial:❑Trailer Court ❑ Motel ❑Other Number of living units---- Number of bedrooms ______Garbage Grindert Size ---J4��__��_�___--.._:- Water.Supply: Public System and name ---------------------- --------------------------------------------•-----------------------------------------Private Id L —Character-of-soil to-a depth-of 3-feet. 'Sdnd-W�Siit❑ "`_Clay ❑Peat-❑�� Sandy Loam ❑ Clpy toairi;❑' "" "�`'� Hardpan E] Adobe ]] Fill Material --/V'! -- 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 seepa pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT { ] SEPTIC TANK' Size___ X--- ___� _______ Liquid Depth ---� ._._--..._ Capacity _l.'S - ---- Type PI�- _ Material��- _-_ . o. Compartments --,.........:.... stance to nearest: Well _____________________Foundation ____/U 1--------Prop. Line ___i5_ .- LEACHING LINE { No. of Lines ------Z------------ Length of each line--------- _�----- Total Length ----Z_,5 dd� 'D' Box __ Rad,Type Filter Material ad, ___Depth Filter Material ----/7_-------------------------------- Distance to nearest:nearest: Well .____ -------- Foundation ------�_0---------- Property Line. __�7._.____ SEEPAGE PIT [ ] Depth ____________________ Diameter ---------------- Number ---------------------------- Rock Filled Yes '❑ No Water Table Depth ------------------------------------------------Rock Size ---------------------- Distance to nearest: Well________________________________________Foundation ____________________ Prop. Line _...___.._.__ ........ i REPAIR/ADDITION(Prev. Sanitation Permit# ____________________________________________ Date __________________________________) r Septic Tank (Specify Requirements) -------------------------------------------------------------------------------------------- •----------------------------- Disposal Field (Specify Requirements) ------------------------------------------------------------------------------------ --- -- ---------------------------- -- -- i ------ -- ----------- --- - (Draw existing and required addition on reverse side) I 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 Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I 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 Wor man's Compensation laws of California." u Signed --- ---- -- ------ ---------------------- Owner r a"L �_p BY r Title --------------------- --------------------------------------------------- (If other than owner) i k j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- --1-`.XNi P-'--'---------------------------•--------------------------------------- DATE -------- BUILDING PERMIT ISSUED ---------- ---L --------_-------------.DATE --"---------- -------------------------- ADDITIONALCOMMENTS F ------------------ --- -----------------------•------------------------------------------------------------------------- ------------------ ------ a # .- - --------------------------------------------------------------------------------------------------------------- - - -- --------- `-`--�=--------------------------------- ------------ Final In ection by: - Date ------- .. r ] N;11 z SAN JOAQUIN LOCAL HE=ALTH;'DISTRICT E. H. 9 1-'6$ Rev. 5M