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F-R'OFFICE USE: <br /> i; <br /> APPLI -t TFON� OR-SANITATION PERMIT`'`,., C �� •� <br /> i <br /> i a. -` -Permit No.L_v_-L0!- <br /> ` (Complete'In Triplicate) <br /> 1 - t <br /> G <br /> F ._ + } � I Dbte Issued:,/,v--7_a <br /> __________________________________________ ,;This Pefm'itExpires 1 Year.Frorn!Da#elssued <br /> Application is hereby made to the San Joaquin Local Health District for. permit to construct and'-in talL...the work' herein <br /> s described. This application is madelri compliance with County Ordihance`No. 549=and existing'R'uI I and Regulations: <br /> OB ADDRESS/LOCATION __�_ -_6_ P -----'" _ - ,CENSUS TRACT ------------------- <br /> - <br /> ` l #"�[ , <br /> 'Owner's Name Xr,% ,Pearl--- d►:lgent 11 4 <br /> —. .; Phoned- - - ------" <br /> ,Address -------------------- 4 916 Paloma__. city S 4ektQn ` <br /> ------ :--- yam; Y i <br /> + n - - ice License # -26],_737- Phone A65.._J8798------- <br /> I Contractor's Name Pal .e$__ Septkc Tank-.AerV <br /> Installation will serve: li Reside6cV- � Apartment House❑ Cori'mercial ;❑Trailer-Court;[D--.f <br /> IflNotel F-1 <br /> Other';_---- -'---------- <br /> �,.Number of living units:__-____ Nurrfber of bedrooms -_-_______Garbage Grinder _no Lot Size ---50._x_.1-54_____:-__. _ . <br /> Water Supply: Public System iandame - ` = Private-T] <br /> of soil to a depth{of�3 feet: Sand'E]., Silt❑ Clay ❑ -Peat❑ Sandy Locim--tJ1 `Clgy Loam o <br /> I Hardpan ❑ Adobe EX Fill Matbrial <br /> ------------ If yes, type ___.__.p.._____-�.------`, -- <br /> =r iI <br /> {Plot plan, showmg'size of lot, location of,system in relation�to`we'lls,=buildings, etc. must be placed on reverse side.[ <br /> s . • <br /> .''NEW INSTALLATION: (No septic tank or seepage �i�errr..ed"if:public sewer is available within 200 feet,) <br /> �. W F <br /> [ ] [ ] } <br /> VZ <br /> PACKAGE TREATMENT EPTICTANK+ S,ize------------------------------------------- Liquidspepih .t-------------------.-•--- <br /> f <br /> Caps'cityTYP -----------------__ Material No. Compartments ---------------------- <br /> Distance to nearest:_,WeII- -----------------------------I------Foundation ---------------------- Prop. Line -------------:.--_.--- <br /> LEACHING LINE [ ] Nd, off Lines ___.__ -_--__ Length of each ,line.-___4W _____________ Total Length 40-1____.___________-_-__ <br /> w D'`'Bd� AO _—e'Filter Material __rOG$�_-----Depth Filter Material __._____ _ <br /> ' Distance`to nearest: WeIG _ 0 _ -- t <br /> r r -: <br /> .....�.?. r � - --- - Fou dation._.____10--•--•-•---.:.P.roperty..line.�-5- <br /> r SEEPAGE PIT [ ] Depth a A___g____ -Diameters <br /> --- Number -. __.__1.--.- -------------- Rock Filled Yes No . <br /> l Water Table, De tK ___ ' Rock i t , F' <br /> a.. <br /> Distance to-nearest: W P ___________ <br /> '' t � t <br /> `� Well ------�{3�`�`` l�us �--•--.Foundation -1�----_.• _Prop..,,Ling _.�__-�-��6--._•..-- <br /> REPAIR ADDITION(Pr v. San itation.Permit# ____._-._____ _t __.- -= __�.__ Date ____________ _____________________) <br /> �. ,1 Il i <br /> i ----------- <br /> Disposal tnk (�Pecify-Requirements) ----------------- w` �-------------------------- ---------- <br /> -------- <br /> Septic <br /> Fjeld. {Specify-)Requirements) --------=------------------•--------- ----='-t---------- = r <br /> ------ <br /> , = <br /> t� 1 W ----------- I <br /> !,. <br /> rt /-- -------------------------------------•----- __ <br /> r•`�` '(Draw existing and required addition on reverse side) <br /> " I hereby-certi r � �� � ` <br /> / i fy,that I have'preps fed this application and that the work will be done in`accordtinte with San Joaquin f <br /> County.,0idinantes, State Laws;.,and.:Rules and Regulations of the San Joaquin Local Health District!"Home owner or licen- <br /> r , .i ; ; h . <br /> i sed agentslsignature certifies the'tifollowsrig: f <br /> "I certify'ttiai,in the performance t+f•thei•work for which-this permit-is issued, IYshall-not.employ any person in such manner <br /> as to became sZ 'ect to Workman's Compensptio laws of California." ` <br /> 4 d} } <br /> Signed 1 <br /> ' ,. ----------------------- Owner: <br /> B <br /> Y C------- - - h' Title _Owner:-_ "PaY -Les_I Septic Tank Serv. <br /> other th ner 0.. W&'than <br /> r / <br /> FOR-DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY `'_ �. ,-. - <br /> -- DATE <br /> BUILDiNG'PERMIT ISSUED ------- -- `- ! q� ' _ <br /> ADDITIONAL COMMENTS -- --- --- -------- - ------------- <br /> ---------- <br /> ---------------------- --- - - ----- <br /> ----------- <br /> --------------------------------------------- t , <br /> I-b-ijo----- - �a�e rd�z�j�a------------------ <br /> ------------ <br /> -`-------, !---.f----------------------------- ----_-- �--- --- <br /> Final Inspection by ------------------ !. f -- Date _. .S 7 d,. <br /> •f fi ` lk <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT Cs�Cj <br /> F. H. 9 �X1-'68 Rev. 5M. ' <br />