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FOR OFFICE USE- - <br /> °SA <br /> APPLICATION 1011 NITATION PERMIT <br /> Permit No. .7 .......... <br /> (Complete in Triplicate) <br /> .•�, This Permit Expires i Year From Date Issued Date Issued 76/ <br /> Application is hereby made to the San Joaquin local Health 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 Regulation$: <br /> J013 ADDR� ES5/LOCA N ' __........ .C9NSUS..TkACf' . CA6. ....-. <br /> Owner's 'Name A�' > . E � .lC _G,7 ..4?:....... . . . .... ?.phone <br /> Address � Q•-'�. . :_ ._%i4.�_p .... .. CityE .... l ` <br /> .. <br /> Contractor's Name ..... .4gr,.'l 1 F license , 5 a� Phone <br /> ••. <br /> Installation will'.serve:,,,..,�,•a..__ ; Residence (�Apartment;Hause�Q Commercial QT <br /> rallecCourt ` ] <br /> In <br /> Motel C]'Other ............. <br /> Number of living units:....1_....'Number of bed"rooms Garbage Grinder _:_.....'__. kat Size <br /> k Water'Supply..Public System acid name-- •- .:-----•- .... . - t-"x- j ................� Privat <br /> . - - • -•- - o(� �► <br /> Character of soil to:a depth of 3:fee#: Sand❑ -. Silt❑, ClayQ" PeaY❑ . "Sandy L'aam W-• -Cloy )corn ❑ ; <br /> f Hardpan Q ' Adobe'[] Fill M6ter►dl . If yes;type ; ___ _ �.. <br /> (Plot pian; showing size of lot, location of system: in relation 'to wells,' buildings, etc. 'must be'plated'on reverse`slde.) <br /> NEW INSTALLATION: (No septic tank or seepage;pit permined-'if p6blic'sewer Is available iMthlh'200feet-j <br /> ' %...,0... ..:.. <br /> PACKAGE:TREATMENT [ .), SEPTIC TANK 'j Site ... :...: ....c __---.moi : r Liquid°Depth <br /> t Capacity . r0 __Type'��t'L,"GMbterial.. ... No:h Corrtpartments-`...�.......... <br /> Distance to nearest: Well ._a_.:.�. .Foundationf ` .Prop,-Line=. .. <br /> :. <br /> 3-•..-• • Length of each line.. _ Total Length ..c� <br /> { <br /> LEACHING LINE [ ] No. of. Lines _ , •- <br /> !• .... <br /> I i . z th 'Filter Material :...Z.1,-.>......:...... <br /> •.........� <br /> D' Box.. Type Filter;Material , .` ep.. <br /> 1 / <br /> i Distance to nearest Well 4 6 Foundation Property Line <br /> SEEPAGE PIT :[ J Depth :..______ ________.. Diameter ......... Number :... _.._..-- . Rock VFllledJ Yes No,C] <br /> ' Water Table Depth -- Rack Size <br /> - - .. .... 1 <br /> 4 P- ”"""Disfanee to nearest-Well -� .. ........Foundation.— �l'rop ••Line <br /> A- ,f..-., , Y .. o ' - <br /> REPAIR/ADDITION{Prey:-Sanitation`Petmlt# `.':._.. <br /> Sepiic Tank' (Specify'Requiremenfs) '' : -� _ .. .. .. ,' ` .. 7 ................... <br /> I` ;Disposal Field- (Specify'`Requiremenfsj` �.'... . `... '. 7 t77 <br /> • -...................... ........_....:. -._.._....,...... <br /> (Draw existing and required addtion;on reverse side) <br /> I `hereby eerrify shat"I':have-prepared`this application-and that the•works will be-$one -in taccordance,with San..Joaquin <br /> County.Ordinances,. Rul <br /> .State-Lows,.and es. RcL,Regylations.of_the-Son JoaquinsLocgl Health District'Home owner or:Iicen- <br /> sed agents signaturecertifies the following; <br /> "I certify that.in�_th6-perfo mpnce of'the work'for-which this;;perrhit�is lssved, i shall nof•employ any..pers' .in..such manner <br /> ai to become subject W km n` Compensation Paws of California " <br /> Signed ` . .- . Owner _ <br /> s sY -- -- -----=------------------- --_. ... xitle <br /> (If'ofher"than•owiier) ... . �. f ,..._. ,..,.,,.� t..., 3... ,. <br /> FOR',D RTMENT USE ONLY l ° <br /> APPLICATION"ACCEPTED .. : .,.DATES <br />�D: BIJiIDING PERMIT ISSUED ....._ -- .. ; - ......DATE <br /> r ADDITIONAL'COlNlV1ENT5 r` - = :::' ' .. ` ..: i. .. F <br /> ------------------ <br /> ' , . .i . .......................a `. <br /> Final Inspection by: ........ J ........ Date &, I _..'. <br />