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v' <br /> S <br /> FOR OFFICE USE APPLICATION FOR SANUATION PERMIT i el C <br /> Permit No. 6* •'a � <br /> •• - <br /> (Complete in Triplicate) <br /> Date Issued/�:a?a*J <br /> This Permit Expires I Year From Date Issued <br /> Application is hereby mode to the San JoaquinnLocal <br /> ecwith CounHealth District <br /> Ordinafor <br /> n,e No. 54a oral ex sting 7ulesinstall <br /> nd Regulotionsherein <br /> described. This application is made in c p <br /> 7/ �j� �- 1,L� I'I �G of I� CENSUS TRACT .`. <br /> JOB ADDRESS/LOCATION phone .. .. ................... <br /> �..----- <br /> _.. .. . .. <br /> Owner's Name /1� - _ _•"- <br /> ...... City fHt✓/ .-.. ................ <br /> Address / ! �J� /a� 1 ( Pnane -Y-1, <br /> F•►.. <br /> `7 �,� �'/'y/2� �/`� License ,. .a,yC��// n <br /> Contractor's Nome <br /> Installation will serve: Residence�Apartment House r-1 Com <br /> ❑Tioil•�r Court =' <br /> Mote! ❑Other <br /> LQfi ................ <br /> Number of living units: Number of bedrooms .-3.....Garba�e Gender Lot Size Le ✓Private <br /> " .-. <br /> .. .... . .... <br /> Water Supply: Public System and name ... .- .... . <br /> Character of soil to o depth of 3 feet: Sand]� Silt El Cloy ❑ <br /> Peut i7—I Sandyy L loom ❑ Cloy loam ❑ <br /> Hardpan❑ Adobe ❑ Fill Material . r•~ :f Yes,type <br /> ells, buildings, mint be placed on reverse side.) <br /> (Plot plan, showing size of lot, location of system in relation ',a wf t�. <br /> NEW Cli <br /> INSTALLATION: (No septic tank or seepage pit perm" —A 'f Public sewer is a.aiiahle within 200 feet,) \ <br /> Size.��X lQ..-X..�� Liquid Depth •...__-_ <br /> PACKAGE TREATMENT ( � SEPTIC TANK[ ] ' <br /> ��0_. Type�('� 77k&w � No Compartments ............. <br /> . <br /> Capacity Material r'-f � P - '�"""---'--- <br /> Distance to nearest: Well 6Y . . Fourdci_:an ProP• <br /> Line ....".......�.... <br /> .. ....-. .. .. <br /> �r- � No. of :fines .� length of each line 7S Tetni Length f-. <br /> 0............ <br /> LEACHING LINE [ -r <br /> / ..................... <br /> 'D' Box . Type eilter Material /�-f .Depth Filter Material .. � - _ � , <br /> Distance to nearest- `.✓Pet 1f;-0 r Foundation Property Line .tP--.................. <br /> Diomete� iJumba Rock Filled Yes (—i No .0 ? <br /> .�FPP GE PIT [ - Depth <br /> -- Pock , - <br /> Wator Table Depth - .. <br /> Prop. Line ............. -••--••- <br /> Distance to reurest: Well .."Foundation P <br /> %EPAIt)1ADr1ITICiN(Prev. Son;toti:n . -mit <br /> Dote ) `' <br /> Sep am-K ,Specify Requiromema <br /> Disoo- ala tSpecif, Regvircn gal <br /> (Draw existing and required cddltion cn reverse side) <br /> I hereby y that I ' ��a prepared tris ooplication and that the work v.il! bc: donf it cordance with San Joaquin <br /> County Ordinances, State I. -!s, and Rules and Regulations of the San Jor.quin lo:ol !{eulth C..t.'iC1. �iar12 OY%ne! cr Licen <br /> sed agents signature cert!fies ttse following: <br /> '•I certify that in the perfortrrim � of the work for which this permit is issued, 1 shat! nat ec pla'i any person in such manner <br /> as to becnrr subject to <br /> 1-1 's's Compansa::-•haws of California." <br /> Signed x <br /> By <br /> t r than <br /> owned <br /> (if o he <br /> Fc:•^ DEPAPTirtENT USE ONLY -: __- f, ►': <br /> APPLICATION ACCEMED ' ' DATE <br /> BUILDING PERI-MT ISSUE ' G <br /> ADDITIONAL CJ?�"t• -11 i7 F" <br /> ::r^,I <br /> rj <br /> u q '-"h3 <br /> x <br />