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FOR OFFICE USE: <br /> APPLICATION FOR SAWA-tl6N-PERMIT e7Y 6�Zd� <br /> Permit No. --------------------- <br /> (Complete in Triplicate) <br /> $- <br /> �--------__JD.te Issued 7_-__,2............. <br /> AV-0-------------- 1 <br /> -------------- -------------- This Permit Expires I Year From Date Issued <br /> Application is hereby made to the Son 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 2-0 WexistinQg Rules and RjeVi,1Ttions-,b1_7—,6A1(/00 401 <br /> JOB ADDRESS/LOCATION w ------- ----------------------------CENSUS TRACT <br /> 'Vo -P , <br /> ---------- <br /> Owners Name A!3-0�K-&O,A/ ZA JMlqlV ------------------- --------- ------PhoneS J' 79,9e <br /> ------------------------- ------------------------------------------- ------------- ----------------------------------- <br /> Address ------- --------------------V--- ----------- city ------------------------------------------- <br /> ------------ <br /> Contractor's Name ----------------------------------- ---------------License Phone �C_ 3'-0--;_ <br /> Installation will serve: Residence EA_4_artr;i—nFHouseP Com"m,ercial [:]Trailer Court ;E1 <br /> Motel F� Other ---------------- ------------ <br /> Number of living units:_-- ------ Number of bedrooms -____Garbo` lge Grincl:rA*��---- Lot Size -------------- <br /> Water Supply: Public System and name ------------------------------------------------------------ -------------------------------Private <br /> Character of soil to a depth of 3 feet: Sandf-I Silt F-1 Clay E] Peat E], Sandy Loam FA--'-Clay,Loam.E] <br /> Hardpan EJ Adobe E] Fill Material If yes,type ---------------------------- <br /> size. I <br /> (Plot plan, showing of lot, locatia n '6fsysf6-'&-TR-FeIation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank 6r seepage pit permitted if public sewer is availab <br /> ,,Ie within 2001feet <br /> I I - ---------- <br /> PACKAGE TREATMENT SEPTIC TANK'[ Size_-'K--�K --------- Liquid .Depth - <br /> U, <br /> Te/ ?SW Materia No. Comparti-hents <br /> Capacity/ ............ <br /> -------- yp <br /> Distance to nearest: Well <br /> -- J- ------------------------Folipdation ------------ Prop. Line .. ................. <br /> 1 /_;9 .., <br /> I 1 1 z 0 <br /> LEACHING LINE No_of Lines ------ of each'line----------------r----------j Total Length --------------------__-- <br /> 4i 114� 1 <br /> 'D' Bo -'-Type Filter Material AKA Depth filter Material <br /> ................... <br /> R,tstance to nearest: Well -----------Foun-d-drib, ----------------- Property Line~_____.___---------- <br /> A <br /> SEEPAGE PIT D�pth ----.-------- ------ Diameter - ------ Number ------ -------------- -- ---Rock filled Yes E] t4o 0 <br /> Water Table Depth ---------------------I ------------_R Size_._ --------- ----------1 <br /> n, <br /> 01 <br /> Distance to nearest: Well ------------ ---------------------L...Foundation ----- ------- Prop,". Line _-__-___-______-____-- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----- ----------1 Date <br /> -------------- <br /> ------------ <br /> `46irenients) -------- --------------\-------- ------- ----' <br /> 1 1 <br /> Septic Tank (Specify Re ---------- -t �Cfj - --- ----------- --------------------------- <br /> ------------ -- - ----- - ------- ----------- <br /> - <br /> -------------------------------- 4_1------------------- ---- ---- --- --- -m------ ------ --------J-------------------------------------------- <br /> ------------------------------------------z----------------------------------- --- ----- ------- --------- --------------------------------------------- -------------------------------- <br /> w <br /> (Draw existing and required addition on reverse side) <br /> LN <br /> I hereby certify th'at7l have prepared t9is a' plication and th4ethe work will be done in accordancl with Son Joaquin <br /> P I/ I ') I % I I I <br /> Rules' Regulations of,'the County Ord inanc6s,TStat6 Laws, and R San Joaquin-Local Health, Disktrict. Home owner or licen- <br /> sed agents signaf�,ure`-ierti`fles the following.- <br /> "I certify that in the performa ce of the which this t edr I hot,employ any person in such manner <br /> , n -L- permi is issu <br /> as to become subject to Wirkmal !s.Compensation-laws,of.Gaiii.ornia."i <br /> .-S,i,g.n-e,d, <br /> -------------------------------------------------------------- Owner <br /> i e <br /> By ------ Titl ----------------------- -------- <br /> --- ------than C\- <br /> --------------------------------- <br /> FOR DEPARTMENT USE ONLY <br /> f -7. 7-;2 �,6 <br /> APPLICATION ACCEPTED By DATE --- ------------------- ---------------- <br /> BUILD­I-NGr-P1ERM-IT--IS-SUED L' q6ii�, 4`4----------------- <br /> ------ <br /> ---------- ----- T Di X= <br /> A,�---- U- ------- <br /> ADDITIONAL COMMENT <br /> 74.U <br /> V ------ <br /> �75--- ---- -------- - ------ ---------------------------------------- -------------------------- <br /> - --------------- <br /> -------tf,,*1Z�Fvk <br /> ----------- <br /> Final Inspecti - ------- ------- -- - ---- -- <br /> --------- --- ------ -- ---------------- ------------------------------------------ <br /> ---Date ------------- ----------------- <br /> - - ----------------- ----- --- - ------ ----------- ------ ---- -- -- -- <br /> SAN JQAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68'Rev. 5M, <br />