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s AOR OFFICE IJSE: APPLICATIONI~OR 5 N PERMIT � Permit No. . 7G (Comple4e in p Ifo ! Dale issued .................. (Italian . .... ....:.. .......... � .. This Permit Explres'l Year from 19ate Issued y p pp is hereby made to the.San Joaquin Local Health District for a permit to construct and Install the work I11e110ist .E Inscribed. This application is made In compliance with County Ordinance No. 549 and existing Rules and R"ulef $' S lO ul• uy.,4 y....�..z- CENSUS TRACT J' i............. 'OB ADDRESS/LOCATION 7 . . '�7J��'v W.f�•�i�vr/ �L. .... . ..... .......... .Phone 4 .. ..... .. ..3.. )wner's Name ..... . .......... , ................. aCi mo• :antrador's License# 0S1.�..!. Phone Installation will serve: Residence F7(partment Housorcial : , ❑Trailrr Court ] Motel❑Other ......................... '- : .............. Number of living units:.. ..-"..... Number of bedroom• .V-P .Garbov e Grind �.. Water Supply: Public System and name ...................................... ...........Pflsrate i x r Peat d Character of soil to a depth of 3 feet: Sand![I Silt❑ Gay ❑ So Loam ay Loam❑ Hardpan Q Adobe Q Fit oterlol ...... .If yes,type• O w , t<4d!1 (Plot plan, showing size of lot, location of system In relation ells, builds s, etc. mutt placed an rwetw - ., s NEW INSTALLATIONS {No septic tank or seepage pit per i public sew is available w in 240 f"M PACKAGE TREATMENT } SEPTI:TANK ] ..... Depth .......................- t d 'T e� .. at�►rial...... ............... No. Compartments ...................... 1 Capacity ,,L;�I t . Distance to near est: We11 :.'.: ..... Q ....I.....Foundation ..... ................Prop.Line .................... � k LEACHING LINE O No. of Linea . .... ................. Length of Ino. ................... ...... Taro( len D' Box ...... ..... Type Filter Mate its.. .... ....Depth Filter Material ...... ............ ...................... Distance to nearest: Well ndation .• ft Line - SEEPAGE PIT I 1 .. Diarr+eter umber Rock led ❑ hlo Y ,.: Rock 5 ... Water Table Depth ................................. }.... r" Distance to nearest:Well ............... ........ ........Found on ......... ..-....... ti ;,.....; REPAIR/ADDITION(Prov. Sanitation Permit# ............ ........ ........... I t7 ... Septic Tank ISpecify Requirements ........ .......... ........... Requirements] is e.+i!�e-..` .... ..,. �. (Specify eq a0.'...._. ._......T ..... Disposal Field 5 �1 �........ Q.. . .............. ..:......................... . ...... (Draw existing and requires(addition on reverse side! N area this application and that the work will be done in a�a�W^ p I hereby certify that 1 have prep x County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local HeaHh Disttilet.Meme ewster M 9 sed agents signature eertlfles the fofiev"g: in such manlier f "I terrify that in the performonee of the wank for whish fists pernsit is Issued, I aha(! not employ any persew a s= as to I»conse subject to Workman's Compensatlon laws of califernla." + ...................................... Owner Signed � ............ ......... tl Dam .. /A•� - Ti e Owner . . ............ ................. .. . ,f-.,.o f otI .r than owne r By . A r) E ARTMENT USE ONLY .r.-,� .._ .�._._. ....... »�. DATE ....... .. s APPLICATION ACCEPTED BY. ..X/:. . . ....... ,DAT€ ...................... ......... BUILDING PERMIT ISSUED ... ...:....... ... ._........................................... .... .. . ....... . ADDITIONAL COMMENTS . ... ... . ..................................................... . ..,'.. ..... ..... .. .: ....,....'.. Date �•.7�. 7�................. Fin3 1 Inspection by: . . . I 13 24 1-61) ftev. y?9 SAN JOAQUIN LOCAL HEALTH DISTRICT f3/7>, 3M EI Y 'S'