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l <br /> FOR OFFICE.U c r <br /> Arn;CA1I0N..F0 SAWTATiON PEP-MIT <br /> {Complete in Triplicate) <br /> ��_ � .I_• +T iCi 6x ------ Date'i35118d <br /> This Permit Expires I Year From.Date,lssue3" <br /> T <br /> Applicat un is hereby made to the San Joaqu:r,L.ical l-leaith District for a permit to .con;frust and install the work herein <br /> described-this application is anode in compliance with County Ordinance No..541? and existing Rules and keViotions. <br /> �, �[ -- ._r�C _ G *�.C.NSUS TRACT .: <br /> .308 ADDRESS/LOCATION _ ..��-.�, /r ._.. �-,- ^� <br /> h <br /> Owner's .Nome. t P <br /> . /C ,� ,? �� . -/ ,., arty <br /> Phone <br /> Address • w t <br /> Contractor'.s Name �z�4 /LG�iI.- •.-.,....-. C cense#a!�r•' _. Phone16 2G 9 <br /> Installation will serve: ResicTence 'Apartment House f] Comr,ercfai ]Trailer Court r^ <br /> Motel E]Other- -- •----- <br /> .� g ( . .,. tot Size <br /> Number of living-unitsr.%t _.. Number oFrooms - Garbage Gander40 <br /> c. _ .,_c`_'_ ...................:... ..•,_.Private B <br /> . <br /> Water Supply: Public System and name .. .lx. <br /> Charater of sail too depth of feet: SondO riltD Clay PentC Sandy Loam C1ayLoom <br /> Q" <br /> , <br /> t Hardpan[j Adobe Frill Material ........ --if yQs,type .. _ <br /> {Plot.plan, showing size of 7ot;_ __,i o:i of system in relation to wells, buildings, etc. rnust be placed on reverse side.) <br /> NEW INSTALLATIONt iyo septic tonic or.seepage pit permitted if pubhc sewer is available within 200 feet,) <br /> PACK_S,2:3REATMEir'T .[ 1' SEPTIC TANK ]- Xl3'%�l axe'- ------•- ._,.- liquid Depth <br /> MS <br /> Capacity ___.._ T --- 3Vtateiial_..c._. No. Compartments <br /> Y • =---- YP <br /> Distarxe to .nearest: Weil �...........................f=oundation ------ °-•-.- --- Prop Line <br /> LEACHING LINE: th <br /> No. of Lines : Length of each Eine..__..-.l�Q ...... Total Length <br /> } <br /> �d <br /> _-.De th" vilter Material ...11Pi.............................. <br /> 'D' Box _.+.�.__.. Type Fdtf"r.Material ..�� p <br /> Distance to nearest: well:: ._e���/ -.-. Found7tion Id � Property line ..� <br /> f " <br /> .. <br /> SEEPAGE PIT. yam' Drpth eZZs_.-.,.. i7iameter -t � __-- Number .-.. ... Rock Filled Yes.f�; Nod] <br /> Water Table Depth :;._ cra,' ......._. Rock Size ...._� <br /> y <br /> Distance to nearest: Well . .....Foundo'ron / d Prop. Line. <br /> REPAIR/ADDITION(Prcv..Sonitation Permit yds.... -,. ................. Date _. . - � , l <br /> Septic Tank (Specify Requirements( .. ..,........- <br /> Disposol Field (Specify Requirements) ..3 �1.� _ 7� ,+ <br /> ......... '. .�'.. .. ! / !._. . __../..:0: .. l�� .C7..±t!T_T`" <br /> ..........6; _ <br /> C <br /> -- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 ,have prepared this application and that the work will be done In accordant* with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of:the San Joaquin Local. Health District. Horse owner or ilcen- , <br /> sed agents.sigrature certifies the following: < l <br /> "I.certifyr�thai rmit i• In <br /> Issued, 1 shot! not employ any person In such manner <br /> In the performance of the work for which this pe <br /> as to becosna subject to Workman's Compensation laws of Cailforniu." <br /> Signed ................... -- ....... Owner <br /> y Bye:r« /L7.r'- "!�` - '"`^'"` :.'` r.CG"! • ...... <br /> �.,.-- --- rale <br /> pf other than owner) <br /> FOR DEPARYOAENT USE ONLY <br /> 3 APPLICATION ACCE TED 13Y..i 1 � DATE .__ !l <br /> BUILDINGPERMIT ISSUED ..,._. --....._ .. ,. ........ ....._.......... ............. .....------------DATE . . ..................... <br /> ADDITIONAL COMMENTS .. . _ <br /> :-�-----•--- ...--�--......_:, _._.... .... ........ ....... ..._.... . ...:.... .. <br /> .. ... .,._ <br /> ._..__,.._ � ��s. ... <br /> Final,Inspection by:. l,w��` '--- --------------------- ..... .. .... . ............. .Datr .. , ... <br /> SAN JOAQUIN LOCAL HEALTH MSTP.ICT s. <br /> 1-'68 Rev. 5M �f <br />