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r µ. _ .. FOR OFFICE USE: APPLICATION ��R 5q = / NITATION PERMITernL� =----/- -.-.---- ------------ (Complete in Triplicate) 4� `'T/_� � Permit No. _- - � I ------ ------ -------- This Permit Expires 1 Year From Date Issue Date Issued 3 i 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 y;i1 Co tyOrc�ance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION 1 �y�, --- ----------------------------------CENSUS TRACT Owner's Name ._i/1c .ter, 1/ �/� �r�%------------------------------------------------------- Add -------- ----- _ _ Address ------- ---------Phone -------------------------------------------------------------- ------------ City ------- -----==---------------------------- Contractor's Name _. f� -_- -� �j� -��--�-- ------ -, -------------- ------- -License #�»-�J-- Phone Insta llation will serve: Residence aApartment House,E] Commercial Trailer Court { i Mate! EJ Other ------------------------ ' -------------------- Number of living units:--- Number of bedrooms _ _______Garbo e Grinder / ... g 1.�I,�_- Lot Size f-•r�-�--- -��- Wateyr Supply: Public System and name ------------------------------------ ! / -- ----------- Character of soil to a depth of'3 feet. Sand'E] Silt 0 Clay [] Peat❑ Sandy loam .E] Clay Loam ;0 � " ; Hardpan Adobe [] Fill Material ------------ if yes, type ----------------------- -- (Pl'ot 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 feefi,) � � PACKAGE TREATMENT [ ] SEPTIC,TANKX Size f /�------ Liquid Depth _moi . ------ ---------- Capacity „�t1U-��IeC.Type / Material__ ' Gf�' ,� lo. Compartments ----------------es (!� Distance to nearest, Well _______- ___ , 7 t ' r Foundation-------------.Prop. Line LEACHING LINE ,[ No. of Lines --____�_-._______-- Length of each line___-_� ---1-�-------- ----- Total Length ---f��---1�.............. 'D' Box/ Type Filter Material 43?4A-- Depth Filter Material ___ __- Distance to nearest: Well _.__j` 1-_ - a —� ------ Foundation -- ---�-- -------- - Property Line --�- ---------=-•-•--- Depth SEEPAGE PIT .� -------------------- Diameter ---------------- Number ------ ___-___ Rock Filled Yes © No Water Table Depth ------------------------------------------------Rock Size --- ------------------- -------- ` Distance to nearest: Well -------------------------- '"" t ----------Foundation ---------------I---- Prop. Line --------------•••- p (Specify -------------------------- Date ------ f ADDITION Prev. Sanitation Permit�# _______.__--____-____ - Septic Tank Specify Requirements) _________- isposaf Field (Specify Requirements) ---------------------------- -------------------------- r , -------------------------------- (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 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 i$ issued, I shall not employ any person in such manner as to become subject o Work 's Com nsation laws of California." Signed ---------------- -------- - - - -- ------- -------- Owner BY ....r 'Title - --------- - - ------------ oche th n owner) a ,FOR-DEPA MENT USE ONLY , APPLICATION ACCEPTED BY ._. _- -----_�5-- -� BUILDING PERMIT ISSUED ---- -- _-- -- -------------------------- QATE -- 7� -- ----- - --=----- --------DATE ------{---- ------------------ 4 A A DQITIONAL COMMENTS ------------------- -- - I - - --------------- i _ ---------------------------------------------------- --------------------------- -------- -------- =--------------------- - --------------------------------------------------- - ---- -- - s ------ -------- ------ -------------------------------------------- ------------------------------------------- --- Inspection by: - -- ----------------------------------------------------- ------ -------Date - -- -� X_,71 SAN-JOAQUIN LOCAL HEALTH DISTRICT i E. H. 9 1-'68 Rev. 5M.