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•.- 411 LI A1UJltl IVK :�'tIKIIA1hJN VLlUitll 7G .F- <br /> (Complete in Triplicate) Permit No. ............_...... <br /> This Permit Expires 1 Year From Data Istued Date Issued ../........... <br /> _APM4 tFe reby made to the San Joaquin Local Health District for a permit to constrict and install the work herein <br /> — desscri/bye�d. Tlei <br /> hi} Epp on Is made in compliance with County Ordinance No. 549 and existing Rules and Regulotionsl <br /> Yo 5-3 ON ...-£. Fs C_ CENSUS TRACT . <br /> — Owner's Nome ................................................._. Ph _......._... <br /> y� _._..............y ...........-.i.,.- <br /> Address .-"...":.---.:. _...:'" ......;7.-�--�-----•`----------..................------•----CI � . . ....._._. ._...�•---.__.-_ <br /> Contractor's Name ............. ----------------------------License # <br /> Installation will server Residence Erl(partment House(j Commercial❑Troller Court D <br /> Motel❑Other - ....... ----•----------•-•••---- <br /> Number of living units_.__._. Number of bedrooms ._,-3----Garbage Grinder -__________ Lot Size ..j�%_`_ •-- <br /> Water Supply: Public System and name ...........__........_.................. <br /> _---.__...---•-----_....---•--.___.___Private <br /> Character of soil to a depth of 3 feet: Sand Silt❑ Clay ❑ . Peat❑ Sandy Loom ❑ Clay Loom ❑ <br /> Hardpan❑ Adobe❑ Fill Material............ If yes,type-------__._. ._—__._ <br /> — (Plot plan, showing size of lot, location of system in relation to walls, buildings, etc must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If Public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK j S ..... -------_--- Liquid Depth ...... <br /> Co d r, 1:_(� �(! E.7: T ''fir'/.� 'p- <br /> Capacity _.-: Type t-------.�__..�_ Material No. Compartments -_.. -` i <br /> Distance to nearest: Well _ ._...u__..___.____________Foundation _:,r.__�_________ Prop. Une__ �!10 <br /> __ Q <br /> — LEACHING LINE ( No. of Lines < {._ ?'_ Length of each line%'._l. U._..___ Total Len th .___...__. _ <br /> •D• Box _..v ateriai ��epth Filter Material Type Filter � 1. <br /> C <br /> i <br /> Distance to nearest: Well .._..:...-/.._._....... Foundation .J................... Property Line _.—_. <br /> SEEPAGE PIT [ ( Depth .................... Diameter -----------_--- Number ._..... .................... Rock Filled Yes ❑ No (3 <br /> Water Table Depth ..._....................____..-----_ .__Rock Size .........__ <br /> Distance to nearesth Well ..._.:...____ ..._ Foundation ___._..__ _. Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit¢ _____.__.________.._____-___:___ Date <br /> _ Septic Tank (Specify Requirements) ......................... .._:_._.._...._..__..__._..___..._____._...—_...._._..__..._.._..—__..----•------ <br /> Disposal Field (Specify Requirements) .................._—----__-----------_-_--_.---_____._----__-_ ............ ......_... <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 accordance with San Joaquls <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Home owner w 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 becom subject to W,q kman's-Compensation laws of California." <br /> L4 _ • G`?J_l i <br /> Signed ...-- -•--'-•--••------...._.. ...--,._--...---•-----'--...�-.._..._...� Owner r, <br /> pf other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ............ ... ..................................... ......•.. --- 7JZZ�.... DATE ...�� C: 7�_----••---• --_: : <br /> BUILDING PERMIT ISSUED ..... .._ --• <br /> ............... ------_1 -.........- .... ..............DATE ._... .._........._.... --------- <br /> ADDITIONALCOMMENTS ................... ------------------------------------------- ---------------------------------------------.--- -----------••--•------•' - <br /> ................... .................................................... -•-------------••--•---•--------------•---------•••----------._-_-.._.._.....•••------•••••--------._.._._-----•••- <br /> ....--•-•----- ------ ----------- ................•-•-...._.._._.._---- <br /> ..............._............................................-_... <br /> 'n­o­f inspection 6y: . - _...._...................... -... .'A4-_------------Date _..."/o.a r�.,ZG......- ._.. <br /> EN 13 2h 1 8 Rev. 5?f SAN JOAQUIN LOCA HEALTH DISTRICT 8/7h 31'1 <br /> T&I5 1 S c1 C0 Py 0f -b'k! O1,4 fter r topv .,af ft p4N-antY <br />