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FOR OFFICE USE: f 14'PPLIC1210e,ATION ARNAfiN�TAI-TION PERMIT D� Permit No. -.Y✓!= ` f (Complete in Triplicate) t _____________________________I-----------------------____ 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. 349 and existing Rules and Regulations: ---1--- 7 JOB AADDRESS/LOCATION .-�-_ -y _ _ __�_ __ CENSUS TRACT _9---7------- --- Owner's Name ---�� ------4--a-ZI—b-----------------------------------------------------p-------- - -`--,--�-Phone ------------------------------------ An Address . -------- `l- ------- e1P--------. City .��Cl CU ` ;- ��'-------------------- ---•---•-- Contractor's Name —------------------------------------ ---------.License # ---------.-------------- Phone --- 7d/,10 Installation will serve: Residence W Apartment House❑ Commercial ❑Trailer Court I❑ Motel ❑ Other -------------------------------------------- V Number of living units:--.----- Number of bedrooms -2-------Garbage Grinder A-0_ Lot Size ...�_'X� --------- Water Supply: Public System and name -----( Q--r---------------------------------------------•-----------Private ❑ Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe & 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 ------------ - v Distance to nearest: Well ------------------------------------Foundation __.------------------- Prop. Line _.--------..-:......_- ' -1 LEACHING LINE [ ] No. of Lines ------------------------ Length of each line---------------------------- Total Length ---------------:___-___._--_ 'D' Box ____ ------- Type Filter Material --------------------Depth Filter Material _.__--_____-________._________.______.____-_ Distance to nearest: Well ------------------------ Foundation ------------------------ Property Line ---------------- ------- SEEPAGE PIT [ ] Depth Diameter ________________ Number ---------------------------- Rock Filled Yes ❑ No �] Water Table Depth ------------------------------------------------Rock Size -------------------------------- Distance to nearest: Well ----------------------------------------FoundcItJon -------------------- Prop. Line --------------._----_. REPAIR/ADDITION(Prev. Sanitation Permit# ----�R/4_-Z_2---------------- Date ___) Septic Tank (Specify Requirements) ---------------------------------------------------------------------------------- -------------------- �r------------------------- Disposal Field (Specify Requirements) --- �- --------------- Q----- -- - -- --- --- - -- ----------------- ------ ------ --_----•----- ------------------------ -- ----------------------------------------------------------------------------------- Dr6w exist ng 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 San 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 beco a subject to„Work n's Com nsation laws of California." Signed ----- -------------- Owner BY -- -- ------- Title ------------------------ - ---- ------------- ---------- (I er than owner] FOR DEPARTMENT Lt E ONLY APPLICATION ACCEPTED BY ----- - -- -------------+----------------------. DATE BUILDING PERMIT ISSUED -- ---- --- ------------------------------- ---------------------------------------------- --------------DATE ------------------------------------------- ADDITIONAL COMMENTS - .- -- ----=--------------------------- -- -Q -moi Final Inspection -------------------- �.�---P-G`-' ,.. - - - ----------------- ---- -------------------------------------------=------- " - -- -- r - Date p Y ------------- -------- N JOA OCA HEALTH 1 E. H. 9 1-'68 Rev. 5M