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'*'v"i 1rvac T <br /> r FOR_OFF`;A-; <br /> SE.. , .. ...p��. <br /> iPPElCAf01 FOR SANITATN PERMIT <br /> d � d Permit No. �. <br /> .._ :+ (Gomp ell e=iniTriplicat ) <br /> - ----- -•--- <br /> TZ �" I �_S-1y Date Issued -�.-_�1. <br /> ----------------- -_--�.-- -.--- _____.--.--- This Perm t�Expi ear From ate Iss�d'sn- P <br /> Application is hereby made to the San Joaquin'LacTHealtfit�`b` ~ ...r a <br /> ist ict for permit to construct and install the work herein <br /> described. This a plication is made in com l.ianceh Cory Ot manc ' No. 549 and existing Rules and Regulations: <br /> JOB ADDRE /LOCATION `_V�---Q�! ---------CENSUS TRACT -------------------------- <br /> Owner's Nage �„��Ll� LTTYF --------------- ----- --------- - Rhonee � 9�� <br /> - ---- --- `� <br /> Address ...4------------ 1�1' I <br /> Contractor' ty <br /> sJill <br /> ame LAX- t_P_vC------- $AP �'���cense # -�5434�..-- Phone�6'3841- <br /> �� L <br /> Installation serve: Residence Apartment Ouse O'kCOmm,�er 1100E]Trailer Court ;❑ <br /> totel r Other ----------- <br /> i <br /> (Number of living units:....._._.._ Num r o bedrooms .. ._._...Garbo a Gnder op.--_ Lot ize ---- ---------- <br /> ---- --- - -- <br /> ater Supply: Public System and name .: •--- 1 __-...- '� <br /> L1F 1�J �P.� ,- t Private ❑ <br /> _harractier of soil to a depth of 3 feet:' San d:Q silt Gay ❑ ,Pea ❑ Sandy Loam ❑ Clay Loam;❑ <br /> `I'°� <br /> Hardpa p ❑ Adobe Fill M�eria -------- If Yes, type ---------------------------- <br /> (Plot plan, showing size of lot, location of cyst in relation to Xeells, uildings., etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or st- a e" it irmitted if ubl' <br /> P P g p p pAat <br /> is -se w� rWis available within 200 feet,) <br /> PACKAGE TREATMENT_ [ ] SEPTIC TANK f . Size---- -_---- _--------------- Liquid Depth --------------------------- <br /> ti.,wwl, ----------- <br /> apaci;ty" - Type rilo.Lmclati <br /> --- - -------- No. Compartments -------_---•---- <br /> i Distan ene rest +l/e <br /> .a «._ o.M <br /> LEACHING LINE [ ] No. of Lines ------------------------ Length f each ._ _.. Total Length _.._._ _.. <br /> V1 <br /> _ _ D, Box . fps Filter Mater a- `� S,D�ept_ Fr1t�r Mate►iml _ _... - <br /> _. <br /> Distance to nearest: Well ------------------------ Foundation _______--------.--- <br />` SEEPAGE PIT [ ] Depth - ------------------ Diameter ---------------- Number ---------------------------- Rock Filled Yes '[] No .0 <br /> Water Table Depth --------------------------------------- --------Rock Size -------------------------------- <br /> Distance to nearest: Well -------------------------------- ------Foundation -------------------- Prop. Line -..--•----------_.---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ..._.--.---.--._...-.--.._....._..) <br /> Septic (Specify Requirements) -- + ___-- - ------�-q_-,-----a---�- <br /> Disosal Field SecRequirements) <br />+ GP-_-- 2AiraA --Q--T------_ <br /> ----------------------------------------------- <br /> ------------------------------------------- ------------------------------------------------- <br /> - ----------------------------------------------------- <br /> (Draw.existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <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 become subject to Workman's Compensation laws of California." <br /> Signed Owner /�,f <br /> By -- --- - - - ----------------------------------------------------• Title ------i-± <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYsd-------------------------------------- DATEf- � .--� <br /> BUILDING PERMIT ISSUED ------------ ---- -- DATE <br /> --------------------------------------=----------- ------------------ <br /> ADDITIONAL COMMENTS ---- ------------------------------------------- - <br /> --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ ------ <br /> -------------------------------------------- --------------- 14 <br /> Final Inspection by- ----------- <br /> ----- - - ---- - Date �C 2 . -.-) <br /> --------- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 1 <br /> E. H. 9 1-'b8 Rev. 5M <br />