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FOR OFFICE USE: AppL1CA'1ZION FOR 5ANlTAT{011 PERM{ Permit No. ... - -'o?�u•� <br /> ` {Complete in Triplicate) <br /> i <br /> . ................... <br /> ,i Date Issued �•�.�='..•. <br /> _ <br />...... _ .._ _�............................. ... This permit Expires 1 Year From Date Issued <br /> ................................ <br /> Application is hereby <br /> made to the San Joaquin local Heoith(D'+strict for <br /> a permit t o d existing <br /> construct and <br /> all the work <br /> described. This application is made in comp <br /> lion Rules tand Regulations:fein <br /> ce with County <br /> .f 11 C7`.........._.. ...............0 <br /> JOB ADDRESS/LOCATION _ - ' ho <br /> Owner's Name .. ' (?..11 .City i . _.Yl. _ =`n......................................3.._..... <br /> Address ....... �. - ...................... ....... <br /> �, }'C- license # .G.d'� _�..._ Phone .... <br /> -�-- Contractor's Name .. a�.co.-IC.-L�:..� �•---• '� . .. ._._. <br /> Residence[g Apartment House Q Commercial []Trailer Court Q <br /> Installation will serve: . <br /> 1 Motel Q Other -----.................••-••----------..---• Q ..�a �1. - <br /> 2...Garbage Grinder _.__.__._... Lot Size ..--- <br /> Number of living units.._)...... Number of bedrooms __... .._.._....Private <br /> I Public System and name ------------- ---••----••-----••-..---...---•----• ---------•------_---....-------- , <br /> j Water Supply: µ Peai'Q Sandy'Lo�am {] Clay Loam <br /> l Character of soil to a depth of 3 feet: y Sand 0 .Silt Q Cla � <br /> Hardpan Adobe ❑,.Fi{I 1Nateria4 °4,If yes,type'p... - <br /> • �`` laced on reverse side.) `C <br /> _buildings,_etc._Tusf be p <br /> (Plot plan, showing size of lot, location of�sy-sten►rin-refatiort_to_w.ell.s, . i l <br /> No se tic tank or seepage pit permitted if public sewer is available within;200 feet,) <br /> I NEW INSTALLATION:! ( P 'I- "" <br /> i ° /O..__ Li u��l Depth .... <br /> SEPTIC TANK-[�' size........ r� ..�_ •-• ........ _a--;—, <br /> PACKAGE TREATMENT- [ ] en s <br /> AQ? ct_L Type n ..... Material. <br /> .r.e.te. mpa Li -1 <br /> ,No. Co <br /> - --•-... _ ... ` � t. �m a ... <br /> t <br /> Capacity ..,l 3!P <br /> __ ..- --� --- io p, n <br /> 4 Foundation -..,lam pro r <br /> Distance to nearest: Well ._.-.l U- ---•----•• �'_ <br /> F I Total;..L ngt�.,.l _.... <br /> No. ef,lines _._ .__._... length of each line..._.!-.-. <br /> I LEACHING LINE [j�}i --......---•-....--•• <br /> D' Box ... �.. Type Filter Material _...___ ---.•---Depth Filter Materal <br /> y r r f <br /> '',_ �_ Foundation ......1 .......... 'rop qty Line ... � <...__.. <br /> Distance to nearest:Well ......_ -- - No ❑ <br /> F Rock Filled Yes. <br /> / Number <br /> - Depth Diameter ..... �_ , <br /> SEEPAGE PIT �(j --- <br /> Rock Size -.._....._ ' <br /> Water Table Depth ----•--••-. =:.� •- <br /> r <br /> V. � --Foundation --.---���.--... Prop. Line .._f� <br /> r Distance to nearest: Well.--/ - <br /> ��•: <br /> �:. <br /> - -------- <br /> :.1 Date ---------------••-••---....._...._y <br /> REPAIR/ADDITION(Prev. Sanitation Permi �, ..... ........------......... -•---- <br /> r( -- <br /> r-Septi4c.'Tonk (Specify Requirements[ _.._.._.... _ 1 _y -_'�-_-• <br /> 4 <br /> (Specify Re uirementsl - � . <br /> Disposal Field (Sp fY q , <br /> l -•-------•-- ........... q........ <br /> 3------------------------- I-------------------.._ .. (Draw existing and required addition on reverse side) enc orda with San Joaquin <br /> i 1 Hereby certify that I have prepared this application and that tie-work will be done in a <br /> County Ordinances; State Laws. and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licen- <br /> 1 <br /> sed agents signature certifies the following: <br /> i °'l certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such mariner <br /> 1 <br /> as to become subject to Workman's'Compensation laws of California." t., <br /> ..............••---- Owner <br /> ---•••-- ;�. <br /> ► j - ................ Title ..... <br /> By ..-- :__ ..... . <br /> i (If other than owrier) <br /> FOR DEPARTMENT USE ONLY <br /> ° ..... DATE ...._ . �:'`�--- --�-�--7--------•-•:._..... <br /> APPLICATION ACCEPTED BY <br /> DATE <br /> BUILDING PERMIT 'ISSUED .. ...'............::...........•--...--:....-•.....__......_..:.......-----..._..--•--.........._ <br /> ,.. <br /> I ADDITIONAL COMMENTS .. ................... <br /> ._......--- •. ------....-•-.........-••-----_... <br /> ' -----•----..... .................... - .........---•-•• ...-. <br /> i ._ --...•------------•--------------- Date ..-... _ . <br /> Firiai Inspection b • ----------1-------------- <br /> 3 SAN JOAQUIN 'LOCAL H DISTRICT }yam <br /> : _.._ _� .. __' .rt•. - -- F - 71723 M <br /> CIA - - <br />