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` <br /> FOR OFFICE USE: APPLICATION KTATUON PERMIT <br /> Permit No. <br /> .z�� ' ` '^' -- --- <br /> ----'— N���pN�ein ?r�licatm <br /> ------- Date Issued .- -- -''/ <br /> This permit Expires 1 Year From Date Issued _ <br /> - | co� i made to Joaquin Local Health Oi�d"t for o �n|t to construct and install the work herein <br /> k "�p ' °"" ''~'~~� ''' � U [�h County Dr�inoncn )�n 549 and existing Rules and Regulations.� . 6e�z|6e6. This op�|/co�iun \u made l� compliance vv . <br /> � ^- � ' -----_- --CENSUS TRACT -------------------------- <br /> Owner, <br /> ------'-- <br /> ' ___ - Name , _ . P � <br /> 7 ----------------------------------- <br /> -------- <br /> ----._-- <br /> - <br /> Add . ---------------------------- <br /> ---------- <br /> Contractor's Name --- <br /> .__ _[nntroctor'sNomo - --'&-'^---License # -' Phone — ' ' ----- <br /> Installation will <br /> -`|nmoUotionvU| � <br /> uo*m. ^ Residence �� A�orhnen� Hovoe�� [ommerdo| �]TroUe,C�v, �� <br /> � <br /> Motel [] Other -------------------------------------------- <br /> ' <br /> � ~�u�Number of living units. ----- Number ufbedrooms --�"--Garbage Grinder -�/-. Lot Size '---Y,-='�»��u���-'- <br /> �~ Pdvo� '� <br /> \�o�r Supply: Public System and name ---------_.---_----.----__----_-----'---- <br /> Character ofsoil toodepth of3feet- Sand'[] Silt F clay Peat E] Sandy Loam [1 Clay,Loam E] <br /> Hardpan E] Adobe-M. Fill Material ------ ----- |fyes,type `---------. <br /> ` <br /> (Plot plan, showing o|zo of lot, location of system in m�uNmn to wells, buildings, n�. must be placed on reverse side.) <br /> . � <br /> NEW INSTALLATION: (No septic tank o, seepage pit permitted ifpublic sewer isavailable v,* TINhhn �U8fao�) <br /> PACKAGE TREATMENT { ] SEPTIC TANK ' Size----- - <br /> --- Liquid Depth -.-��-/--------------- <br /> -3)(9 <br /> ------3>(] Type -.a~°�� No [u -~~�=.----Copoc�y ----_ <br /> » <br /> Distance to nearest: Well ------------------Foundation ----- ---------------- Prop. Line --- -'-'' <br /> 8VG UNE No. of Lines --. m�--�-- Length line-- ' ../-- Toto iem �����^n �-��. <br /> �/�n � Length �^�p <br /> 'D' Box .. --- Type Filter Material ---�/4I---------Depth Filter Whoxakd -------- <br /> Distance to nearest.. Well <br /> --DistnncatoneonesmVVeU ------------------------ Foundation ----------- Property Um6- --------- ------_'.-�'-'- <br /> ~� ~' -�PAGEP|T { ] Depth Diameter —_ Number -----�---.. Ruck Filled YmuT� No �] <br /> ---����-- --' <br /> -��k � ~ ' <br /> Water Table Depth ------'_-_'—_-_ Size .—.--_'_-'- <br /> - - Dimnncn �� neomm` VYwU ----------------------------------------Foundation ._-'_—. Prop. Line --------------- ...... <br /> -^ .� <br /> (Prev. Sanitation Pern �# ��� Date ' ' ' <br /> ] <br /> ` <br /> Tank (Specify Requirements) ---------------.---_-------_-__--_____.________.__.. � <br /> Cxepono| F|o� (Spedfy Requirements) _-_._'__-_--'--_---.--'--''----_---------' <br /> ` <br /> .-'—__--'_—'__—__._-_—��_-.—_--''^--'--_--- ' <br /> -°~—_---_-----.--�--_- � <br /> ^ - <br /> ------���------����--'—'---'^'---'—'----- --''^'-------'-'-' <br /> '----������� Drov�exio�ngom6vequireJoJ6Nonon ,aveme�kd� <br /> -~^ <br /> / y hereby r�rHfythmt I have prepared this application and that the <br /> work will be done in accordance with Son Joaquin . <br /> CountyOrdinances, <br /> S^mhm Laws, and Rules and Regulations of the Son Joaquin LmwmU Health District. Home wvpnwr or lUwem~ <br /> ..;�-�­°=cl-agenrssignature certifies the following: <br /> � "V certify that in the performance of the work for which this permit is issued, | shall not employ any person in such manner <br /> ' <br /> as t9 bb �� �m laws of California." <br /> - O�/ <br /> � <br /> 9i 6- �. -.. - ---'_------ u�/nm, <br /> | ------ <br /> By --- - ------------------------------------ ------------------------------------------------------ /mo ----- -----------------.--- <br /> (|fotherthon owner) <br /> ` <br /> ( <br /> � <br /> ' ----- <br /> BUILDING PERMIT ISSUED ��--._� --''/~��,�,�-.--'u*/c -----��—_—'_''' <br /> `~ ^. <br /> ^`*~�*. \ODR|ONAL COMMENTS ---_—'—��--._----_.-----_--_.---'' <br /> � .'--'_�—.—.--_--`��"-��� -----'-'— <br /> � --�--�-----.—.. -----.---.- <br /> | ____.______���--._'—.-----_�����---' --'---------'-'--'— <br /> �,._-_- - <br /> - ~`'----'----- --'------''�-- --------------------------------------------------- - --'—'—' 7r <br /> �~�~-Fno| |nspec�on6y -----_'-_—_—.--- < �&�����-�.r --'-'— <br /> i ' ' --'--'- <br /> �0N JOAQU|N LOCAL HEALTH @4�RICT <br /> - P l''68 Rev. 5N\ <br /> � _ <br />