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FOR OFFICE USk: i <br /> AM CAO FOR S <br /> ! ! Tf N R ANItAttON PERMIT <br />............. . ...............................h. .... Permit No, ..7 <br /> (Complete in TApllcote) <br />............: I .................................... This Permit Eipires 1 Year From Dote Issued Date Issued <br /> 6 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulatlonsr <br /> .DOB ADDRESS/LOCATION .......�iQ.��....�.....��� .................... . ....... ......CENSUS TRACT _................... <br /> ...... <br /> Owners Name ....... ......... <br /> .._--•- .... y . .. ..._ . Phone .................................... <br /> .. ..... .................Address . _ _ ....... ..0 .......... ............ .....................Cit <br /> a <br /> Contractor's Name . . .. ��` .... .. .........License # c2-C.11..'1'_.r.. Phone <br /> Installation will serve: Residence O(Apartment House❑ Commercial❑Traller Court ❑ <br /> Motel Q Other ........................................... <br /> =x <br /> r <br /> Number of living unks:.---_f___ Number of rooms .. -..,-Ga��rbegee G—rinder ..' 'Lot Size ..���..•.. . ... �---..... <br /> Water Supply: Public System and name : . . ..# i:.°rf .c .. ...................................................#rrlvate❑ ' <br /> Character of soil too depth of 3 feet: Sand 0 Silt❑ Gay ❑ Peat E3 Sandy loam❑ day Loam ❑ <br /> i Hardpan❑ Adobe ' Fill Materlol ............If vast................ ............ i <br /> : <br /> (Plot plan, showing sire of lot, location of system In relation to wells, buildings,�etc. must be placed on reverse side.) <br /> N611 INSTALLATIONe 1'!No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> s <br /> PACKAGE TREATMENT I [ T , SEPTIC TANK 'Ax( f 1",L/ a.4�._. `.. `. Liquid Depth ........................ <br /> Capacity TYPe . , .. ...... Material. ..... fNo. Compartments ......................d <br /> t Distance to nearest: Wet l' ......................:.............Foundation ...................... Prop. Line ......_............... <br /> LEACHING LINE l .NoGof_Lines.t. ,1:.--•....... .length of.•e ch Ii e:_. Gl...�........... Total Length .(_,9........... <br /> 47 l 10 <br /> 'D' Box .. ./... Type.Filter Material :; '..Depth filter Material . ./A....`............................ <br /> . , Distance to nearest: Well .)1 G0-fir.).. .... Foundation Property Line ...C............... <br /> SEEPAGE PIT Depth Z�7S.7r...... Diompeter ...... Number ---...../........... Rock Filled Yes No 0 <br /> t <br /> Water-Table-De -­ l..�f. ........_...:. ` .......Rock 5iYs ..v�......................... <br /> i Distance to nearest:5 Well -.. l-�. ........Foundation ... Prop. Line ..•.► ....... <br /> REPAIR/ADDITION(Prov. Sanitation Permit . ---•---. Date .................................. <br /> Septic Tank (Specify Requirements)..........:....... ...... ........ - ..... ...... .. ................ , <br /> Disposal Field (Specify Requheriments) .t._. r ....• jt: . ...... ........... <br /> .. .f ...................... ..:: :::; � .... ... . z : � ... .... .......................................,. ......__..._... <br /> 4 <br /> n <br /> �N - <br /> (Draw existing and required addition on reverse side <br /> I hereby certify that I have prepared this application and that the work will be done In accordamm with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen• <br /> sed agents signature certifies the following: <br /> '°i certify that in they performance of the work.for which.this.permit is issued, I shall not employ any person in such manner <br /> as to become sub(e' to Workman's Compensation laws of California.*, - CIAREPICE'S SEPTIC & SEWER SERVICE <br /> l { <br /> Signed ............ .... ...................4........._..........-----• 4. <br /> ............... Owner 263 So. Oro � Stockton, Calif. 95205 <br /> By� . - --------- Title ......... 'h_Q63.320 ....Gontpactata. ic,., 2SlllI ..... <br /> (If other than owner)' >4 f <br /> FOR DEPARTMENT USE ONLY <br /> APA.LICAT.ION.-ACCEPTED,.BY,..... .... . . ..'_....--•............................:......................................... DATE . :/y?..:�,�------------ <br /> BUILDING PERMIT ISSUED ......DATE ................................ <br /> W <br /> ADDrrI At. OMMEN :.2 * ........................................................••------•_............_..._.... <br /> -... _.�...... ._....� -_ • ... ...........................---- --......---.. ...-....._..... ..._....I ._............._.........I...._.......... <br /> .. .. ................... <br /> final Inspection by: .--.- ........,........................................................Date _. L—,.:/f.' .............. <br /> EHE 13 2h 1-68 v SAN OAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> - <br /> !1 <br />