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FOR'OFFICe-USE:` <br /> 6i PW4�T <br /> I Al I'd <br /> APPLIC� RSA <br /> -7 <br /> (Complete in Triplifatel Permit No: <br /> --------------- ---------- -­-------- <br /> ­--------------I <br /> ------­------- ---------­-11-------------­­---------- This Permit Expires ] Year From Date Issued Date Issued ---9_._-_3A----7 / <br /> Application is hereby made to the!Son Joaquin Local 14'ea'I'th District for a permit to construct and install the work herein <br /> described. This application is made in compliance'With County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESSAOCATION ---------1�_---r_--_7. ------ ,PV T - _-CENSUS CENSUS TRACT <br /> �4 --W -ey_._/ <br /> ------------------- <br /> Owner's Name -------- A------- ------11--------- ------------------------------------------Phone�9_97,? <br /> • <br /> Addr' 'City ------------------------------------------------------ <br /> ?ss --- - ------------_---------- ­- E,---------- 4 7 rel <br /> ----- <br /> Contractor's Zi 3� <br /> actor's Name......471 --1-4 7- 7� --—------- --------License #Z��7:!M__ Phone ---------- _--------_ <br /> ----- <br /> Instal lation will serve. <br /> Residence I]'Apartment Ho' use,E] Commercial:E]Trailer Court ;❑ <br /> MotelEJ Other -------------------------------------------- <br /> Number of living units., _u�r�ee-df-bedro-cw-rs-=.71-----Garbage Grinder ---------_ Lot Size ----------­---- <br /> Water Supply: Public System and name ------------ <br /> ------------­----­------------------------------------------------------- ------- -------- <br /> Character <br /> ------__Private <br /> &hara�cter of soil to a depth of 3'ie el t; Sand�E] Silt E] Clay E] Peat E] Sandy Loam Clay Loam <br /> Hardpan E] Adobe Fill M' lf yes, <br /> aterial _,--------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, <br /> etc. must, be placed on reverse side.) <br /> NEW INSTALLATION: No septic tank or seepage pit ermittbd if public sewer is ailable within 200 feet,} <br /> PACKAGE TREATMENT f I SEPTIC TANK-[ Size----_----------- -1-­-------- ­----_--�'.Liquicl Depth ------_----------------- <br /> t <br /> -----_----------------- <br /> Capacity _- -- _- Type ----- ---i------`--- Material--_--------------­ Nc,74�Compartments ----------__------ <br /> Distan'ce to nearest: Well __ ------------------------------Foursdatio Prop. Line --------------- ...... <br /> ------------------ <br /> LEACHING LINE No. of Lines ------ _______________ L gth of each line_-- ------------- - --_­ Total Length ---_-------------------- <br /> 'D' Bol -J Type Filter M erial ____________________Depth Filti r Material - ---------- <br /> -------------------------------- <br /> Distance to nearest: We I <br /> -------- _- ------ Foundation --------- -_---------- Property Line ------- <br /> -•_------------ <br /> SEEPAGE PIT De Di "Meter Number ------------- ­---­---- Rock Filled Yes 'E] No 0 <br /> --------------­- <br /> pth ! <br /> I " 1 7 <br /> WaterJable Depth ------ _-I 5:j- <br /> --- -------­---­----Rock Size Id <br /> Distance to.nearest: Welt------ -J--- - ---------------Founclat Prop. Line -----------_--_--- <br /> i --_-----------t.... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -----_----------­ -­------------------ Date -------------- <br /> 'A <br /> pit <br /> Septic Tank (Specify .Requirements] _________________ ---------------_ - 4- 1500 <br /> -------------------------------------------------------------------------------------------------- <br /> /��47 1 -7 e " it- i ele <br /> Disposal Field (Specify Requirements) -------------------------------------------------------------------------------------------- <br /> ------------------------- <br /> --------------------------------------- ------_---_--------- -----_-----j © � CF"1 _� ------- ­- ------------------------------------------------------------------------------------------- <br /> � <br /> ---------------------------------------- --------------------------------------------------- <br /> raw existing,an-d requirE�8,addition on re_ve`­rs'es1d6)— <br /> ad this applic'dtio"n work will be done in accordance with San Joaquin <br /> I hereby certify that I have prepare and iH"at' <br /> County I <br /> CU ty Ordinances, State Laws, and Rules and Re'gulaticiiis ei-the San Joaquin' Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: L 1i. 1� <br /> Q., <br /> "I certify that in the performance of the work for which tN` .Wmit is issued, I shall not employ any person in such manner <br /> as to'become subject to Workman's Cqmpensation laws of'61ifornici." <br /> Signe'd - ------ IV <br /> --------------­------------ Owner <br /> BY _1 <br /> J <br /> ­-----------_--_-_--- Title _-_ <br /> FOR -DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> BUILDING PERMIT ISSUED �- ----_----- ------ DATE ------- <br /> --------------­­----L---------------------------------------DATE ------ <br /> ADDITIONAL COMMENTS ­- ---- -------------------------------------- ---------_----_--- <br /> r" I ---------­--­-------------- ---------------------=--------------------------- <br /> ------------ <br /> ------------------------------------------------ <br /> -_---------­---- --------- - -:,;- ---------------------------------------------------------------------------------------- <br /> -------------------------------------- _ ----- ---I-- ------------- <br /> ........ ........ -------------------------------------------- --------­ <br /> --- -- ­------ ------­--­---------------- <br /> :_:---------- <br /> - - -77_1 <br /> ------------ - - - -- ---- <br /> Final Ins --- <br /> --- ----_------_-------------Date -- <br /> ------- <br /> ---------------A--, ----- -- - ------ _411 ----------- <br /> _ - -- --------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> H. 9 I-'68 Rev. 5M <br />