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FQR BFFICE USE: APPLICATION FOR -rrNITATION PERMIT .._.. . .. .......... ............... . Permit No. ....._ ......... .� _.`.---... . {Complete in Ti*iplicatel ... Date Issued ..'- - This Permit Expires I Year From Date Issued 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 with County Ordinance No. 549 and existing Rules and Regulations: I JOB ADDRESS/LOCATION't ......�...R...iR.z..,..R• i�.s�'' ---------- ;F--------- #_v..2. ` Y..-.`_ - Phone.........Owners Name , .Lb�6St��.77......_..Address ...... -.... � ------... --•-•---- -•---- sS as � 3 . Phone - __----._ license Installation will _- serve: Residence E,Aportment House Commercial ❑Trailer Court ;❑ � Motel Other .._. ------ -------------------- Z ` _{ ; Number of living units:..... Number of bedrooms 3-._...t_Garbage•Grinder Lot Size _._ .__.K�0 0 .. � t Water Supply: PublicPSystem and no e _.._ F�. -._. 2�44 __.-.....-•---•---•------,--- ..................•_.._..---.....___Private ❑ Character of soil to a depth of 3 feetSand❑ Silt❑ Clay ❑ Peat❑ Sandy. Loam ❑ Clay Loam ❑ "='s ', _ �.i..--v Hardpan E] Adobe [� Fill Material _._....- ..:�If yes, type ............................ (Plot plan, showing size of+�.l,ot location of system in relat n to wells, buildings etc. .must be placed on reverse side.) NEW INSTALLATION: (Nonseptic tank or seepage pit permitted if public sewer is available within 200 feet,)rL r PACKAGE TREATMENT fir] SEPTICJANK.1 ] Size...,_.._-:.._....__._................... Liquid Depth ...._.._._ ............ I Caacit Type --- ..----- Material-......-.-•-------- No. Compartments -------.-.--_------- P y .. _r. YP —+-- - - . . . Foundation Pro Line .._------- --------- Distanc to nearest: Well . =--••-- - P rn ;I LEACHING LINE_ ``(''•]- No. of 'lines Length of each line...... . .... ...:...- Total Length l 'D' Box..._.." . _ Type Filter Material .... ....... Depthjfilter Material --------............................••-••-- 'Distance to;nearest: Well ..................... Foundation .,.....--._......._. Property line . Rock Filled Yes No SEEPAGE PIT [l '.'^Qeptiz . :. Diameter _.. Ntrber - ❑ i ater Table Depth -:w::.-- ^? -------- .... .....•-.-=-Rock Size _ ----•- , `Distance to nearest i ; Well ........ ......_.____ _.. ..Foundation .... ....... Prop. Line ........ .. �.__ . ..._ REPAIR/ADDITION{Prey!,Sanitation Permit.# ---: ...... ------------ Date ................. :..__-1 Septic Tank (Specify Requirements) ...... -------•----- ---------------- -` ----------_-..------.._..- ...... i Disposal Field (Specify Requirements) ....... K_,8_`_.X._(-a� �_rmu-r� �u i'� 1. .---- -- ......... ...... #-- -------- ------------------ ----... .. .+-�- i / � x.. .� a a r�r;` 4Y C� (Dr ' exisfi g and required ad tion on reverse side} I hereby certify that I have prepared this application and tha the work will be done in accordance with San n County Ordinances, State Laws;tand°Rules and-Regulations of the Son,Joaquin Local Health District. Hame own r. . sed agents signature certifies the following: "I certify that in the performance-of the work for which this permit is issued, i shall not employ any person in ch manner as to beco a sub'Ie t to Workinan"s Compensation laws of California." Signed .... .. ..-y�.,.I?$4... .,..:. ..:.` `-'- ---•----......... ••--------.._... Owner. . ByTitle :�>_.._................ ...... ........................._. ; (If other than'ownerj I E TMENT DISE ONLY APPLICATION ACCEPTED BY ......._.. _ . ------ i4 I -_ . DATE ......J�- J.. : BUILDING PERMIT ISSUED ....... ... ....: --- ----- 4-..........- l DATE ......................------- ADDITIONAL C MI ,. - bS_!.._._.�J__. W_S�LEJf. !/ _ ......... .. ...S.I ... � a'. . .---�-�...... _.bi...... e r. J aFinall'Inspection by: ..._ � .1.h.. - .._...Da _� ---:.._. �.� A TH -DISTRICT �� au C 7172 3 .K �, 13 24