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rWK UFFICE USE: ........... ................ ---------........... aPPucar)oN FOjt saNrrArwN PERMIT ' .. (Complete in Triplicate) Permit No. . This Permit Ex Date #s ................•-•- Expires 1 Year From . .. ...:.............. m Dah issued sued P_... Application is hereby made to the Sari-Joaquin local Health District for a permit to construct and instal! the-work herein described. this application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ..-_._ .-� .-.-i•-f-...•.�.. �'. .�. •�r - �. •........_.. JOB ADQ..R..f..S.r.S...L..O...C.-.-A. TION • --1.I.•� tT ...CE.N. SUS TRACT ........Name � ... ............ .... .....:..-..-'-.. one Contractor m ................ City Or- ........................... ........... ........ ....... ..License . .._.•_.__ 0 Installation will serve: Phonee -' / Residence Apartment House 0 Commercial OTrailer Court ' . Motel Q Other Number.of living units:...,_._.- N ...---....-•--- - _�� umber of bedrooms __ ._:..._.Garbo e Grinder � Sire _ Water Su 9 �• Lot dc!f` ..... pPIY= Public System andfrtame ,••_- Char ....................................................... Private . atter of soil,to a depth of 3 feet: Sand'j] Siffi[) Ga Y ❑ Peat 0 Sandy Loam 0 Clay Loam C7 1 Hardpan D Adobe A Fill iUlaterial ............ If yea,type ' l (Plot plait, showing-size of lot, 1 cation of system.In relation to wails, buildings, etc, must be placed on reverse side.) NEW INSTALLATION:. r (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT f l SEPTIC TANK Ca ci tet , Pa ty Liquid Depth .�1� ..........: pp ` •----- TYpe -�--�--:: Mater.ial�'•� d�r ---. No. Comp V Distance. to nearest: Well --- .- f m a .. .............. ... s f artant � 'r• r { —_- - Foundation 1.10........-.-Pro Line . LEACHING -------- ., P ' LENf:. €No. of Lines ----- Lengthe g .�. of each line:, ` Total � 1 n th ..��'._.... •Tl'l' -.. 'D' Box . _�,J�._ Type Filter Material � -�.i) ;---' _ 'f F p h Filter Material -__ _ __.. d. ..,� _-.�--- ` ys # istanc to nearest: Wel# - 6 ..._--4•*Foundation ...._... Property Lina '../V............... SEEPAGE: PITt?iarneter Depth � Number ..... -* Rock Filled. -Yes No Water Table Depth ..- -----------------..:Rock Size = ifi Distance to nearest-Well -.01 .._- ......._Foundation ---•--•----•- �---�-- Prop. Line .%��--- REPAIR ADD! .. / T10N(Frau. Sanitation Permit ..................... . ' - --------------------- Date --- Septic Tank (Specify Requirements) t Disposal Field (Specify Requirements) ......................... .._.._I..__ -- •--•--- ---- , K , ------••------• ------•. •---------- -- • _____••__ired••-_addition -----..:.---•,...__..4._............_.............•............. ' (brow existing and required addition on.reverse`side) !County hereby certify that t have prepared this applfiction and that the work will be dares in,accodance with San .fooqutn :d ag Ordinances, State Laws, and'Rules cm&Rel gufatlons of the San Joaquin Local Health.alstrict. Homo owner er#leen. sed agents signature certifies the following: "f certify that in the performance of the work foi which this permit is issued .l shall not employ an as -to become subject to Workman's Compensation laws of California." P Y Y Parson in such manner Signed ----- ••------ BY ---•-- ------------ - -- -- - ' -------------------------------------•-- Owner----- ---- ------.. Title . it er than owner! --- • -------•- R DEPARTMENT USE ONLY BUILDING PERMIT ISSUED ---------------- ` f APPLICATION ACCEPTED BY DATA :. - ... ADDITIONAL COMMENTS --._..__.- ._.._.. _ ';= ................... ------------------._._©ATE _ •----- - i --•--•-•------ ----------• -----....._._. ...----• ........... Final Inspection by: .._._. .. +.__ -.� `- ._.: _ ,.. _ ------ .__ .... .. ... Edi 13.2Rev. -� . '�...�... SAN JOA(, IN O ' L HE TH DISTRICT 8/7h 3M