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FOR OFFICE USE: " f� APPLICATION FOR S��TION PERMIT --------- ------ ------------ -------------------------- (Completein Ttplicate] Permif�No: -7_Z - -�- �` This Permit Exp,res 1 Year From pate Issued Date Issued��-_�_�:_7?� Application is hereby made to the San Joaquin\L bl HehlthwDistrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCA ION .--� ---- ------RVVEV R------ --------------------------CENSUS TRACT - '- ---•-- _ -TT-JE --'�------------------------ Owner's Name - �-� --- ---------- - -- - -------- - Phone ----------•--------------- Address ------ �+� 7.76?------ �l - - R�U_E�{-------�-�---------------- city ----=--R1- _�-' "-----`- - - -- -�--------------------------------------------- cense;#,°,_ ;`-,'i= Contractor's Name _-..�"+�� F(�-- _ ---- Phone ------------------------ E Installation will serve: Residence Apartment House❑ Commercial:❑Trgil'er-Courf,{.1[i? �} E Motel El Other .__ 8AT'j_f_RQ0A4 Qril;X Number of living units------ -_--__ Number of bedrooms _-3----Garbage Gr'inder-Y- --L-ot-Size----*^-------------_______--__ Water Supply: Public System and name ----------- !,soil tote d p f 3�feet: :Son t 5�it,.[] i .Clay x.❑ Peat(� Sandy Loam ❑ `Clay Loom.❑ Hardpan ❑ Adobe ❑ Fill Material -- If yes, type---__---- _________________ (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc. must be placed on reverse side. NEW INSTALLATION: (No septic tank or seeps _pit permitted if public sewer is avai ble within 200;feet,} � f PACKAGE TREATMENT { ] SEPTIC TANK [ 1. Size -_---_-__ -__ _ .--- liquid Depth -.-------- _--_-. rr� 1.9 -------------------- -- - CapacitY I------------- --- T e --- r ------ _ MaterialFoun-----,-------- No. Compartments ---------- ......._. y Y Distance to nearest: �Wel dation ---- ----------- - Prop. Line ------------------- LEACHING --- -LEACHING LINE [ ] No. 1.of Lines ----_--------------- _ Length of each line--------------------- Total =length •--------------- D. gO` ------- TYPe Filt r Material -_----- -----_.____Depth Filter aterial __i__'__ _ Distance to nearest: We I -----------------------s Foundation 1Property Line �Od n t ,SEEPAGE PET [ De th; Di ter ---------------- Number -------------____--- - _ -- Rock' F,ifled Yes '❑ No i❑ r6 - ----- ,..: Water TableDepth ------- --------------------------------------Rock Size ----- . t� -� J Distance to nearest: Well -------------------------f.--------. Foundation -_ -____.___--__ -- Prop. Line ------------ ......... REPAIR./ADDITION(Fre_v__Sanitati.on..P_ermit_#_--------------------------------- ------ Date—_- -------•---------#--•--- ) Septic Tank (Specify Req'uirements) ---------� t ------6-14f NC � PR F_ ----------------- Disposal !: Field S ecif Re uirements — f eta [,P Y -Requirements)I -,.��PTc L-�- �-�----------- ----jj lC%Cd - ------+�-f' --------.��--------�'�.'1-pJ�..T: ---�'�-c[f-------L1 nf_ w 1' -= --51�-,�. r►-t. 1�r— - - Cir-X-n mp � � (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 I.A County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health bistrict. Home owner or licen- sed agents signature certifies t e following: j "I certify t at 'n he perf e o he work for which this permit is issued, I shall not employ any person in such manner I asto be ' s ject to W rkm tion laws of California." I i Signed _ 1_� i Owners BY` - ------------------------- --- '--- � Title ------- F (If other than owner) J, - - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __.-.-__7 __�� - • l' 3 `°' . ��% --=_'_ `A_�5 ' \-------------------- DATE -----` _ 13UlLD,ING...PERM ITJSSU.ED ----------- ----------DATE ADDITIONAL COMMENTS - --------------------------------------------------- ------------ -------------- ------=--- -------- - ---------------------- -------------------------- - • - ---- -- -- -- - - ---------- ------ - --- - •---------------------------- . --------- ---------.----------- -• ----- - --.-'-•--- ------ ----- ---------- --------------------------- ---- - - ------------- --Date ---------=------------- --- -- ------ ------Final Inspec i ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 i-'68 Rev. 5M. _ - 1