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F Permit No---------------------- f -- - �= FOR OFFICE USE: APPLICATION f--------------------------------------------- 7 � (Complete in Triplicate} Date Issued-._-�--- --- �-- r -------------------------------------- "----- --- -- --------------- fres 1 Year Froi+t"Date Issued ------ ---- - This Permit Exp' ��' AI - Local Health District for a permit"to,tnstruct and i�sta11 the work herein described. q ication is hereby made to the San Joaquin """ .,. Pp application is made in coin fiance with County Ordinance No. 54 nd existing Rules and Re anon _ _ �. - M 50 Thi pp --------------.CENSUS TRACT.-------- -- �.3- ---:---A one --------- JOB ADDRESS/LOCA I .-. -" � " Ph • .J. - ` - � - Zip-- Owner's Name.- n' _ - city _ d � - n f = Address --- !License -- Pho e Contractor's Name. "gin Commercial ❑ Trailer Court ❑ apartment House ❑ Residence _ - Installation will serve: N ' Motel ❑ Other: -. -- = j S - ----------- ;... .. -- Garbage Grinder_..---------Lotze...._ { Private l �. --------------------- Number of living units:_.-_-.--- Number of.bedrooms, ---- ` r d � Water Supply: Public System and-name- --------- --- = ...... peat[� Sandy Loam Clay Loa_ ❑ kind ❑ Silt❑ Clay ❑ Loom Character of soil to a depth of 3 feet: : f if es, e------------ - ------ Adobe ❑ Fill Material-_.._,------ Yp ] :Hardpan ❑ ; b , _ I lot location of syst\e i-an relation to wells' build i;,gs, etc. must be placed on reverse side.) fan, showing size of (Plot p e it permitted if public sewer is available w� bin 0 t,} p 4 p `/a.! - � = Liquid Depth._1-- -----• ---- SEPTIC TANK ]A" Size_--__ 5 NEW INSTALLATION: f No septic tank or seepage , i PACKAGE TREATMENT [ l � �� .-._No: Compartmesi�ts-'---' -- 1�, `' Ca acct ��!'Ja�04--Type._ Material_.- p - t P n t � � g p = _ r ! � Distance:fio nearesfi: We11._- -� --=-- ------------------------- o" -- - - ---- -- ---- - Foundation_..----� --: -- - = -'._ ro - ---- ---- w. F th.of each Ione- To a1 Len th ____ - fra s LEACHING LINE [ ], No. of Lines . -- 1 ��.' f///I- -Depth Filter MaterialY_.'i� � r�' � D' Box Type Filter Mater.iat`{- r -_ �1/_ ,. 1 Line d ion _. D ` !Property •� r . .�. .+. Foundat N Distanceto nearest: Well . !1_�..--=---- c �-- ""A " i Rik Filled Yes f �-- '- Number .. .............--- . . Depth, Diameter:-- X/' �Z=-- ------ 0 SEEPAGE PIT j 1 p #...- r - ---- -- iz _. Rock S' e_ -- -.• f Depth Water Table Dep] � ! �--- -- � ,K....:.-Prop. Line-.�--------------- --.�- k QDistance. - = i t Q - - ':,Found - - ---- San Cation Perrmitt# -el--------------------- Date ;: L ----------- REPAIR/ADDITION (Prev.l i �r. J t kk'' t 1 Septic Tank (Specify'Requirements)------ = l -- �.__.- -_----- -------------=------ I - - . -- Disposal Field (Spe_cify Requirements}. - = _: ti_.•1.- :--- ---- ._ . . ' - ----------- - - -- - . _. --------------------------- - - - -- - ;; } - - - -- s< County ` --------- ` (Draw existing and r�eq�kred add}tion on reverse side} tication'ancl that fthwotkwill he done inlcord� ance with San Joaquin o n � agents 1 hereby certify that l have prepared this apo t nances State Laws, and Rules and Regulations of tthe Son oaqum�Local Health District. Home owner or licensed ag ' Ord , ,.. -i- ,.• %X i; signature certifies the following: f / play person in such manner as t i that in the perForrrian'ce -of.the work for which this permit is issued, I shall not Im to any p 4 "I certify to become subject to-Work—an's Compensation aws of California." ` r � Signed.. . r •. i�� Owner r - _. -. . -. Title-.:� # 1 { 1 By {Iffother tkan owner}; : 'FOR DEPARTMENT USE ONLY ------------------- �.n k-_ _DATE , " ------ --------------- - - APPLIC'P�T1tONACEPTD�BY----------- �` rM -_.DATE. - f-* k ------- DIV -- DIViSIONASLANNUMBE--------------- - 1 - ------------------ ---------- - -_w .� o- /--- -- ADDITIC>NALrCOMN1ENTS� -- - - r�-- - - - - - - - yf- _ ------------------ ----------------- ---------------------------- - '4' C3 --------------------- ----------- - - - � � -7-1l; . . ' Final Inspection-by: HEALTH DIras 21677 ev 7176 ' _.- . -= n( �. EH i s sa S�N,J OAQU fN 4LOCAL H STRICT