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FOIL OFFICE USE.. <br />APPLItAtl <br />..............•............. ................... FOR, SANk4Y614` PERMIT <br />7,.1 —7, 3 <br />.................. ................. �.t ...... i 1comptefe in Triplicatoj- Permit No . .............. . ..... <br />. ............... ........................... This P011"If EXP 106; 1 Year From 661i Issu <br />App A is hereby made to the Son Joaquin L6&0l,'Health District fora perMit a construct and Install the <br />esc "' b�aec'o T h i 9 n i LE CUPT.," <br />I <br />described. PPPlication.js.modeL I ince"With Col; w&k herein <br />" 0 , <br />7-7 nty Ordinance No. 549 and existing Itules. and Regulotions. <br />JOB AbDRESs'/I.00A'rioN.-...��&--,... <br />Owner's Name CEN TRACT 0 ....... <br />d <br />......... ...Phone .4 <br />Address ...... 07 .............. <br />P . ......... _X0 <br />City 4-0 <br />Contractor's Name-_ 141 - ------_-_-----_- <br />........... ... . . ..... I',, <br />- ---------- - I 'V - <br />.1—Licinse4 ... . .................. <br />IVA. - <br />Installation will serve. 6sidence rtment Nou!ap Coniine I <br />Apa al tailor court (j <br />ate) Other ......... . ................ <br />I Number of living units--./ Number of bedrooms ..%' . <br />GarbO98--GrIn ....... <br />Lot Size ..A� e <br />up &.e . ..................... <br />Water S Ply. Public System and name'.,._.___--__ j - X . . <br />.............. ....... . ....... . ......... ................ <br />Character of soil to JClay <br />e dt. Sand 0Private <br />CS"dy IL, <br />a A' pth of 3 fe Silt Peat so <br />Sandy Loam Clay Loam <br />m-;;,"ardP09-0.. _j�,Oobeo NIM6ferjol.. <br />........... <br />............ <br />(Plot Pldn,' showing size 6f lot, location "A on of system in relation to' wells, buildings, etc."'must be placed an reverse sidel'O <br />NEW INSTALLATION. (No septic lank or seepage pit perr'nitted if public ` - <br />I sewer Is available within 200 feetj (A <br />PACKAGE TREATMENT [ I SEPTIC TANK I 457kP i _ '>. <br />V ./.% v, - 1 <br />Siz ....... ........... Liquid Depth -1 ........................ <br />6pacity-1000111010.._ TypeAe.A Materia' <br />No. "Compa i. <br />rtments-..AQ ...... <br />Distance. to nearest: Well 0 <br />Prop. Une.4 <br />LEACHNG LINE No. f Lengtlji 0 <br />-----­--------- each �I'Ine.8$;_7.9 c'%0TotcjI Length ..4poov, ...... <br />V . ..... <br />Type Filter Material .......... "...Depth filter Materia} <br />............... .......... <br />Distance to`nearest. Well 41 Founclation <br />9 ........ <br />th., Ln.. Dia .................... Propeldy Line <br />Filled Yes No <br />ter . ............ Number -,, .................... <br />TC <br />.................. <br />Size ...:....... ; y <br />Ist Ce n rest. Well ............. . <br />3 ........................... Foundation ........... ...... <br />Prop. Line ................... .... <br />REPAIR/ADDIYION (13'rev. Sanitatl6ri Permit # - <br />Nk ------- ........... Date .....---- <br />Septic Tank }Specify Requirernents) ..................... <br />.................... .............. ...................... . ... ............... .......... <br />Disposal'Fleld iSpetify Requiremenft'l _ .......... <br />................ I .............. <br />.............. ......... <br />.......... .. . ........... ............... <br />I ................ ................... .......................... ...................... ...... ... ....... <br />.... . . . ............. .... . .... .. . ... <br />Prow existing and required . addition - - . ­ o . n .. reverse - s - I . de . ) .................................. L .......... ................ <br />I hereby gerflfr that I have prep6i <br />red this OPPIlcaflon and that the work - will lbe�,Aiiie in'accordance with Son --aJoaquin <br />'County Ordinances, State Laws,ind Rules and Regulations of 4he Son Jaiiquln-Local fl*aIIh-,oIsjdg#. <br />sod agents signature certifies the following- Home owner or 11cen- <br />"I certify that In the I ) <br />p rmarice'al the work for ' e I <br />which this Permit Is Issued, I shelf. not employ any person In outh manner <br />10 t be es le;O&On's-Corripensation laws <br />"an of California. <br />.Sign: ----------- e�� <br />--------- ........................... Owner <br />By .... <br />................ <br />;..;� .......... ! ........... 0_1 ......................................... ............ <br />(if Other than owner) ....... I.._...._.. ....... ........... <br />Rti�TMENT USE ONLY <br />APPLICATION ACCEPTED BY ..... 00K_ <br />BUILDING PERMIT ISSUED ........ ...................... DATE ­ <br />ADDITIONAL CO EWS 6A ---- i ....... ... ....... <br />,ZAM 01 ............... PAT <br />woe—. ...................... ........ <br />------------ ......... <br />............ I ....... .................. <br />............ I ............... .-............ ................................................................I. ...............I..................... .I ........................ <br />. <br />Final Inspection by. ----------- ..-.................... --- <br />---- ............ ....... <br />........................................ <br />EH 13 2h 1-68 Rev ;4 --------------.....................................Date ' <br />SAN JOAQUIN LOCAL HEALTH DISTRICT ZA <br />8/7h . <br />3M <br />