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+ ........... ...... ..............__. .............. ......_ . A!Pili�gT1ON l�Ott S,gf1{RATION . . .. _ (Complete to T li ' ......................_ rip Crate) Permit No. . ._._...._-_ This Permit Expire: I Year From DaM Issued -_ AppllcaHon is hereby - Date Issued l : described, mode to the San Joa urn Local Healt This application is made in compliance with CouDistrict for a permit to cons truct JOB ADDRESS County Ordinance No. 549 and existing Rules nd alr�the w� h, /L TION F,, Owner's N �, g egulatian, Address . .ame...�j�� ---------- ------------------------_.............. Awg� •QCT ,J�Je ?1 Contractor's Name ._ _ ani w... - ...._. .- ...._.... City _... -_- ..... ...Phone . 9: 4. t - Installation will serve; Residence -'.._._...____...license# .,��• . - -- '.`.---•-�-�'' 0•*0m nt House Phone .s. F. 0 Commercial❑Trailer�'otrrt � � Number of living Motel❑t�7fher ❑ ---- . � g units:._..-------- Num ......:......:..�:._ bet of �-_.._. Water Supply, Public System �drooms ire Grind er Char Y m and name ---•----:..___--. ..._:�.......Lot � ....._ . -------................. .. Character of soil to a depth of 3 feet.. Sand❑ Silty-.._._. -�.--------�•- ..._�� -..-.__._.... Ha ❑ Clay ❑ Peat L]-. Sandy —.Private Hardpan❑ Adobe m{� Cray Loam (Plot pian Fill Material..... yes,type showing size of lot, location of System if NEW 1NSTALLA�ON. Y m in relation to wells, buildings, etr- must .....�... , (No septic tank or seepage it be Placed on reverse side PACKAGE TREATMENT E SEPTIC TANK P permitted if public sewer is available within 200 feet,) Capacity .................... TYPe -..._ ... Material. Liquid Depth ........... LEACHING Distance.to nearest: Weil __•_ .._.---•-- --•-- . - Compartments ~.--- No E l No. of tines _. ..._..:..: . tion ___._ ,�; t3 length 4f each line............. Prop. Line_ ._.........._ Box ....._._.... Type Filter Material ....._. ---- - Total _ Distance to nearest: Wel! --- - •----" -Depth Filter Material - . .._... ..__ SEEPAGEPIT f Dept --• - ................ .. Foundation .................- .........................:... Property Line Water Fable -- Diameter -------- Number .- ._. ._ -- -- Rack ._ Depth .... - killed Yes ❑ No [] F it Distance to ngarestr Well ...-....---•-� ............................ , ITION ji'rcv. Sanitation Pe ---------..... ...Foundation Septic Tank rmit . ....._._-----••---------------- -----• --------------- Prop. Line ............._....... (Specify Requirements). Date ......__.............. .l Aisposal Field (S cify Requirernen -_- ._ :_ ,.---•__._.: - _- ..... .. .. .......... ................................... - ------------- ---- .._.' - .. ..... . - ...................................... - ........__. ...._ ......__.--_.... ............... .__.:.. .._. ._ (craw existing ......._...__ - g and required aid �on..•-------------------- t hereby certify that 1 haus. dirt .............:.. ... ......__. Prepared d Feverse side . ..._..�•-- County Ordinances, state L p this application and that, the wo& will awe, anet Ryles and at, at the Son Joaquin Lova!done in accordance with sed.agents signature certifies the following; San Joaquin "I certify that in the performance o►the work Health D1;bfd. Home owner or Item. ►k for which this permit is issued, I shall not eri�ploy as to become subject to Workman's Compensation laws of Cgliforala." r5i9rted......_.... . any person in such manner By.. ..... ..................................... - Owner ..............-- If of er than owner) --------•-•..._. ----- Tithe . APPLtCAttON FOR DEPARTMENT USE ONLY ACCEPTED 8Y_-.•-�'� UltDING PERMIT ISSUED .. ."• ................... 'NDDITIONAL COMMENTS - . ....... • - :._. - .:... -•... ....... ...••---- DATE -.! � - ...... DATE . rinal Ins '� ._. ... -----• _ - ..................• ••-•---•-----••... •........._. ._... Acoon by: ..C. _. ---- --•---•--------- ------------- ................ .............................. 1-68 13 2 :.SAN. JOA to tfE T R } Date ��1�t�......................... .. . . . . AL H._DIST ICT . - ..._. ...._..