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�................ . ........... . ... .. _. .. . ._ -. . _ <br /> E ? r 'st gip, <br /> ►Cutnp'rete in Trtp'rzatei <br /> This Permit Expires f Year From Hate issued <br /> f —AM ' reby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> describect. 'ihts Opp ors is made In compliance with County Ordinance No. 549 and exEsting Rules and Regufati*nso <br /> 1QVI r An r%V <br /> • - - .... _ ... . ...........CENSERS TRAGI <br /> -- <br /> Owner's game 'f! .r. ...:._ .................. •----•--•- -.... phone .................... ..-.. <br /> Address ------ <br /> ------ <br /> ------- - ..»-_City ... :'. ..5--rf '�} .:... ..... .: <br /> z / <br /> ContraCtar S �€ ['t'! __--•- /� <br /> a e __.»� �............ . .:�_._ •:�.----- -.._._.._.._._._._.License # ...................I. Phone :r.....»-•.{..._.»......-----. <br /> installation will servo: Residence artment Howse[] Commercta€OTraTlar Court (] <br /> Motel❑Other--------- •----------------------•---- <br /> r / , - <br /> Number of living units._.._ Number of bedrooms -f -_ Garbo e Grinder = - --. Lot Size . f.�4_.�.�. .::^......... <br /> Water Supply. Public System and name ------------»-_-_--------------—--------------_ --- ---- --- -- ---._ ......_..Private <br /> Character of soil to a depth of 3 feet: Sartd)Er Slit p Clay p . Peat 0 Sandy Loom ❑ day Loom Q <br /> i-tardpan(] Adobe 0 Fill Motorial.-- -•__-.If yes.type............----_.»---- <br /> 3 <br /> (Piot plan, showing size of tat, location of system in relation for wells, buildings, etc- must be placed on reverse side,} <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted If-public sewer is available within 200 feet,) ' <br /> . PACKAGE TREATMENT <br /> SEPTIC TANK " . Size. _ . . --- - -__.._..:. quid Depth ------� .�_,.. <br /> Capacity c` s Typo * tt. ._.....s.{ ;..... • - - <br /> --=-•=------- Mtiaterlal.w. No. Compartments <br /> Distance to nearest: Well- - -----�------------__------Foundation .. ............. Prop. Line -_----tA <br /> .� <br /> Fi. LEACHING LINE [t No, a# Lines ---••------�._._...._._ Lengfh of each line��..___._._.»__..._._. Total Lan th ��».._._� ... <br /> F -- <br /> Box Type altar acoria( ::t...... ' '�;; epth Filter t�4aterial --- -• . '.._..._..-__-. .` <br /> -� { ... <br /> - Distance to nearest <br /> Well ...........------__-._, Foundation .. ............ Property Lln@ `"_'_-_-. .. <br /> SEEPAGE PIT,,- [ j Depth --------------------- Diameter -----------»--. Number -------------- ......... Rock FilledYes © No Q* � <br /> Water Tab]* Depth --- ---------- -.Rack Size %0 <br /> Distance to nearest: Well ------- .. ...--._FoundofIo n <br /> REPAIR/ADDITION(Prov. Sanitation' Permit 4 ---- ------------»._-__ _____-_ » Data -• _- - <br /> Septic Tank (Specify Requirements) ---------•----------------------------_ _...........:................ .......... _ ._.»._.._......._ <br /> Disposal FEela (Specify Requirements) ....... .....-..................»....................._.............».___...._....................... <br /> ------------......... . ..•---------------------------_._...__«._................_..........................-- .. _... <br /> F ---- ------------------------ <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 he doses in accordance with Saga Joaquin � <br /> s + County Ordinances, State Laws, and Rules and Regulations of the Sun Joaquin Local Health Distrld.Home owner or ticen. � <br /> sect agents signature certifies the following: _ <br /> F <br /> "I certifjr thaat in the performance a# the work for which this permit is Issued, i shall not employ any parson to such manner <br /> as to became+ 610 t to W, rk�is//tian't-kompensation laws of California. <br /> Signed t-�4 - ...... - ►-- Owner <br /> By ----------..........- -- --- ....._ ' - ._... '»- - . Title ........._-."� -»---•_. .._.....-----...._•----.._..... <br /> (1#a#her than owner( - _ I <br /> FOR DOARTMENT USE ONLY <br /> Fj APPLICATION ACCEPTED (3Y �1�.... DATE ... ....._.....-:-. i <br /> --•...............•-------...------......_...---...._....... .............. <br /> BUILDING PERMIT ISSUED .--•---•.............:•_--.............._ ......................DATE <br /> ADDITIONAL COMMENTS <br /> P- -------- - .......... -.---------- -----•--•---------------------•-•-----------•---------- •------ •--•-••- - ----- ------------------------------------------------- -» <br /> Final Inspection by ------------------- <br /> ..W.------•....--Date � i <br /> EH 13 24 1-60 Raw- 5H SAN JOAQUIN LOCA HEALTH DISTRICT 8/7h 3H <br /> h S IS a Comfy 0-f 444C OW mer r far 0-F fte r lo <br />