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rvx vrrsu <br /> ............. s�c <br /> ;f . FRSNITATION PERMIT4PPLfCTON <br /> ......................../ <br /> Permit No. ............... <br /> ��' 7S <br /> -... . .............. .. .. <br /> (Complete in Tripllcote) <br /> ' �!(.. This Permit Expires 1 Year Front Date Issued fla/e Issued ..�'. .:. <br /> Application Is hereby mads 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 Coun y Ordinan . No. 549 and existing Rules and.`Regulations: <br /> JOB ADDRESS/L N . .. ...457 .. ...........................CENSUS TRACT._.......................... <br /> Owner's Name .. ........... .Phone�, �e ..-. � . �.� <br /> address . ............. ... � - .. --•......------ _. -- --•-•. City ..... ...... . ...............I..... <br /> Contractor's Name ...... <br /> .._ ... . ....................... ..License ��' �-�3 Phone��. .....?.. <br /> Installation will serve: ResidenceOeApartment House C] CbMmercial OTrailer Court 0 <br /> Motel 0 Other.................................. ' <br /> Number of living units:...,... Number of bedrooms, _.---Garbage Grimier ............ !o#Size ................. ........... <br /> Water Supply: Public System and name ........•--------------•--------- .........._` .----...................................... : Privats)< <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0, <br /> . Peat 0 Sandy Loam 0 Clay Loam' <br /> Hardpan 0 Adobe 0 I'll)-Material ...•........ if yes,type............... ............. <br /> iPlot plan, showing size of lot, location of system In relation to wells, buildings, etc-Ymust be placed an reverse slde. <br /> NEW INSTALLATIONs (No septic tank or seepage pit permitted If public sewer is available within 200 fee#,) <br /> „ or <br /> PACKAGE TREATMENT [ ] SEPTIC TAN Size.. . �...::........•.... Liquid Depth ... ............... <br /> J/ No. Compartments .._ ...4No . <br /> Ca�oacityt/,LPO-Q----- TY - - ._.. Material.... �X�_ .� p �-- <br /> istance o nearest: Well .... ... ................Foundation...,�0........__ Prop. Line . <br /> i_EACHING LINE [ No. of Lines —............ Length of e line �:.,,7.�J_.f Total Length .. <br /> `D` Box . ., ..... Type Filter Material f Depth Filter;Material . . C ....... _ <br /> - Distance to nearest, Well . .�. +.. ..9. Foundation Q..7 ........... Property Line t?> <br /> SEEPAGE PIT [ Depth .�.S...... _Diameter . . Number rg_G . ... Rock Filled Yes• <br /> Water Table Depth ...........................Rock'Slze �X . ........... <br /> Distance to nearest: Well ..,��Q.........................Foundation ... ........ Prop. tins ... ........ <br /> E <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ._...__...................................... Date ..................................I <br /> SepticTank ISpecify Requirements) .............. • . .... . .......... ......................... ...................... ., ....._.............._............ <br /> Disnosal Field (Specify Requirements) r '` r ................................................ ... <br /> ..............................................•---........`..............,........,._.. ---•--••-..............................-•---•---•-----._................__.................. <br /> . ....................•.....................................................................................:` --............._--._.... ................................................I........ <br /> (Draw existing and required addition on reverse side) <br /> t hereby certify tha�I ht�ve prepared this.application.and,that the work will-be dons In accordance wAhh San Joaquin <br /> County Ordinances, State Laws, and Rules and Regui!en Nie San JaaqulniLocal Health District. Home owner or licen- <br /> sed agents signature certifies the(of lowing: <br /> "I certify that in the performance of the work for which this permit Is issued, i shall not employ any person In such manner <br /> as to becolffW-bpblect to rkrna 's Compensation laws of California." <br /> :gnec' <br /> .. Owner -' <br /> 10 <br /> Title .,e..................................................... <br /> ,,�l ,t <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> ... . <br /> APPLiCATfON ACCEPTED 9Y ,- .......... DATE ....... ...:............. <br /> BUILDING PERMIT ISSUED ............ ......... ....... . ............ w DATE-;.:.-/ .................................. <br /> ADDITIONAL COMMENTS ...... . ... .._ Dl ......lf..._. ........................r. ............................. <br /> . ..... _.......................... -----------------... ....._-......-�------..--......................................................................................... <br /> .................................... . -.... ..................-......---...--............ ....--....-----...._..........................._.......--- ..._.. .... ....----... <br /> ............... ................ .. ._.-. ....---- <br /> Final Inspection by ------- -------- - •--......Date ......... <br /> . . . ....... <br /> EH 13 2h 1-60 ijv. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8 A _9 <br />