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• avrrrr�oHrlV'r�l f\dii yf-9t`B[Il1114d E'B �eE2ftllAt /L <br /> (Complete In Triplicate( Permit No. ..7............9. <br /> ............ ....... .. ............ ... .. ....... Date Issued A`0`7-11,22- <br /> .......................... This Permit Expires 1 Year From Data Issued v - <br /> LApplication is hereby made to the San Joaquin Local Health District for a permit to constrict and Install the work herein <br /> desuibed. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRE4 TION °,�✓�r��v.��.. .,��?ce... .....................................CENSUS TRACT .........................: <br /> L Owner's Name ... ........ .................N..../............................................................. .....Phone �...... <br /> Address <br /> - ..: / .:......................... City . <br /> L Contractor's Name ....� . -�------------------ .....................���! <br /> /� ---._-----------------License #�,1.....r.'l..`,�.... Phone .. . <br /> Installation will serves a dance 107- Apartment House0 Commercial❑Troller Court ❑ <br /> L Motel ❑Other............................................ <br /> Number of living units:............ Number of bedrooms .....Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name ...................................-------------------- ......._........................_..............Private <br /> LCharacter of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loom ❑ <br /> Hardpan❑ Adobe❑ Fill Material ............If yes,type............... ............ <br /> L (Plot plan, showing slze.bf IOFlocotion of system in relation to wells, 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 TAN�K�I� Slzze..y............................................. Liquid Depth .......................... <br /> b. Capacity l oD YPa ..L ....... at- Material...................... No. Compartments .... <br /> Distance to nearest: Well ....h`.e./...................Foundation .h ............... Prop. Line .................... <br /> L <br /> LEACHING LINE [ ) No. of Lines .`3J.. ...... Length of each Iine..7Q.................... Total Length 2,2d.-------------� <br /> .D' Box .1........ Type Filter Material ..F"ro�/..�.._......Depth Filter Material .'�� ..............................V <br /> Distance to nearest: We" ....................... Foundation ........................ Property Line .........•........._..6 <br /> s- SEEPAGE PIT [ 1 Depth ....-.............. Diameter ................ Number ............................ Rock Filled Yes ❑ No QJ <br /> m <br /> Water Table Depth ......•......................._....----........Rock Size .............................:.- <br /> .�i <br /> Distance to nearest: Well ...................._..................Foundation .................... Prop. Line ----------:.-....._- . <br /> REPAIR/ADDITION(Prov. Sanitation Permit BOE ...................... ................... Date .................................. <br /> Septic Tank (Specify Requirements) -----•--••............................................................_......_.._............ ._..I......................... <br /> Disposal Fiala (Specify Requirements) •......._...._................. --.-_....................................................................._:.................... <br /> ..............................-.................. .._...........,........ <br /> '$ <br /> ---------- -----------------------------------------------...---------------------------------------------------------............................................................................... <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 Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or Ilcen• <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 become subject to Workmari's Compensation laws of Caltfornla." <br /> ` Signed .-- , .: ........................................... ... ... Owner <br /> ... ........................................ Title ._..-._....._..._-----....._..__.... <br /> By ................................................:.............. <br /> _ [If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _"�1.,.�...... G�� ..................... DATE ....,.�+: G.: Z.T....::.r: <br /> BUILDING PERMIT ISSUED ...... ---•-- ------------- ......................................... ............. -- -•-- --........DATE ....__.. ............................... <br /> ADDITIONALCOMMENTS - . ... ... .__......................--......---•-•-------•--..................-----•----........................ .....----•-.......................... <br /> ........... ............. ............................. ............. .............----................................................................ ................................ --•-............. <br /> .............. .. ... ............ ........ - .... .... --- -•-- ._......................--'-•-•-...... ....... ........................._..._............................................. <br /> - -- - .............. .................. . .. . . - ._.......... . ............................D..a..t.e... ....... ..... <br /> .. <br /> .....Final Inspection b <br /> EH 13 2h 1-68 Rev. Sal SAN JOAQUiN LOCAL HEALTH DISTRICT 8/7h 3M <br />