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,. {,.Y}1%01. P?,Lt A`f _ , a Per
<br /> . . k � � k � ' ,� � ;�� C I N Orq�•,yl
<br /> 1. ., {Campl*to In Yripllcate) niit'Noi .?7
<br /> This permit Expires Year From Date is:ued pate Issutttl
<br /> Application is hereby,made to'the San Joaquin Loc'Eil liQaylth District far a pormit to construct and. }n'
<br /> :tall thn work fi®felri
<br /> y x made In com liaise®'with�' , ty O ri netn a No. 544 and 011fing Rules and Regutsttlon3�
<br /> descrlbvd;1hla application Is'
<br /> ��DO N�rr i�"�� �.�. �r:Am�o t ,
<br /> ,fOB` ApDRESS/LOCATION 1 ' !},A �k` w .G.er
<br /> rrUS......................CENSTRACY
<br /> 4 Owner's I Name iY 0 M Ili, a 4 .c� � }�,, r ,
<br /> ;, ............. .......... .......................................phone
<br /> 42
<br /> `Address# � sd N -.. _ City 4: ....................._•-..:.....:.
<br /> :: •.
<br /> ContrQCtaf;$ R.ty .'h R ':"t..........License # ". ,r i'N
<br /> Installation will serve , Residence El artrnent House o Commercial []Trailer Court {]
<br /> r. „ � Motel�]Other
<br /> Nujo.
<br /> ............................I.........
<br /> a
<br /> Ihlater Su I P Number of bedroarns ...:..:..Garbage Grinder -----.___.-- Lot Size .__... .........................
<br /> p ;living units
<br /> k
<br /> p y ublic System Qnd'name............
<br /> _ ................ ......_..�. _.-------------------... ...........
<br /> -- -- -�.•-.. ...............Private0
<br /> Character of soil to a depth of 3 feet, Sand ti Silt Q
<br /> Clay ❑ Peat 0 Sandy Loam ❑ Clay Loom 0
<br /> P.r. • '1 Hardpan 91 'Adabe'o FIII Material ............ If yes,type ......... ............
<br /> place
<br /> m -
<br /> {Plat on;:showin size sof�lof, location of..system sin relation to wells, buildings, etc. must bed on reverse side.)
<br /> NEW INSTALLATIAN {Na septic tank or,seepage pit permitted if public sevrer is available within 200'feet,l
<br /> PACKAGE;TREATMENT SEPTIC 1ANK} '' r� y
<br /> [ ] Siz ..x . . ..: '
<br /> ', l”
<br /> Capatlty -.. .. .rte'.. Type Material... �..�....... No. Com rtep
<br /> 4 pa menta . .................
<br /> ' Distan : I , S ,
<br /> e to n®brests Well,
<br /> . y P.......---•....Foundation ...r!A Prop. line .
<br /> j" N° of Lines y.. 1�.. g [ each line.. .•,
<br /> ' Length of ea 6 .. ....
<br /> , .- .. Total Length , .
<br /> LEACHING LINE _ .... ..
<br /> D Box .:;,. Type Filter Material 'r.f ........De' Fliter Material !. ........................�
<br /> , .. x a;. Q
<br /> ` �, �' ion Y �" ,t ..... Property Line ..: , ...... .
<br /> S � .... ... Dial ..` �. �. Foundation
<br /> ....�
<br /> SEEPAGE PIT �
<br /> stance to nearest,,We r
<br /> .__. l�J Depth .,. meter .. .-..... Number ..-_.. Filled Yes No
<br /> l Rack ®}'
<br /> lit' s Water Table Depth o 1-.,?;................Rock SizeOL
<br /> i 3' .'Distance
<br /> , to`n.
<br /> sarest: N..e.:l:l..... ... 0:0X ..-- -. •-Found
<br /> ation a'' -_.'.... )P
<br /> rop Line .._.- �
<br /> REPAIR/ADDITION{Prev.',Santbtion Permit ............ ....... Date ..................................
<br /> Septic.
<br /> pe5jfYe ` uiremq ..... . ...............--------......------...........----•.... . .............•.
<br /> Diponal fetc { ' ciy -.-
<br /> �p
<br /> Requirernents) .......----- ..............................•---......................_.
<br /> .I� ........................... . ... Y ............................................. ............................................• r..r:
<br /> r ,
<br /> i
<br /> _... ...__ ..................................,----•---_......-..............:.............- •...
<br /> t lDraw existing and required addition on reverse side) ,
<br /> ...�F . x
<br /> ' I hereby,certify that l have prepared Als application irnd that the work will be done In accardanee with ion Joaqu(
<br /> County Ordinances; State3Lav;rs and Rules:and Rejulatl®ns of the San Joaquin Local Health District. Home owner at' linen,
<br /> sed agents signature certifies`thWfollawltag:
<br /> "I certify that in the perforrtnance of the'eNork foe'which this permit Is Issued, I shall not employ any person In such manner
<br /> as to beiarne Buhlect to Workman's Compensation laws of California."
<br /> Signed ....................................... Owner
<br /> By ................... . ........................... F!?� d,af.� '...- ?.r.� ra....... Title ...
<br /> (If other,than'owner)
<br /> FAR DEPARTMENT USE ONLY
<br /> a
<br /> ' : ; '. -
<br /> BAT �7 C�
<br /> . �APPLICATION `ACCFmA ..BUIL3iNG PERMIT'ISSUED"'.'.,. _ . .DATE .......... ....:......:...ADDITIONAL COMMENTS . ......
<br /> t
<br /> ...... .... .......... . .............. ...... .................. ..................
<br /> h.
<br /> Finoi Inspection by: �.. F'rY , y,s far ap y...:...L...;...I...;........................ ......................... ........ .,.
<br /> P d+
<br /> ... Date ..-...}........ ...... .. . ..
<br /> EH 13 2 ,. 1-613
<br /> SAN -JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M .
<br /> r i' {
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