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; ; R sA��rArr©NRM . . . ... Per-mit-Nt ... 3•- 6 a
<br /> TION ,
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<br /> j jA� 4 �lde DateAIssuet� .�
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<br /> � (�6rttp
<br /> ..... is ter+,; lc$,: 'ra si"a st
<br /> Permit Expires S Year From 0019 l�awed � Qnd install the
<br /> work herein
<br /> Phis P
<br /> constru Rules lie uiatltit► :°e.�
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<br /> :;.,6 .k:•,. ,sfir►ct 6F a p rm
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<br /> OQgdf1(�t15t1r�
<br /> ...................................... uin Local Hea th D tiOrdirrance N rst> ;
<br /> urrd 1'G9�,lut; n
<br /> hereby the San
<br /> Joaq
<br /> ��q and e ;i�s
<br /> made tfl'l.ade< n carnpli
<br /> a►iLe with>
<br /> �r�ty,
<br /> APPlicat;or► ,s is:,m ��i3,rt .. .
<br /> "� s.;y us�i'.rt C1.1
<br /> 1;:cation'- r„,r - d(.[.f�(` .L
<br /> LENS
<br /> I�Io US TR
<br /> . d.-This rsPp .
<br /> cr
<br /> 56 Z
<br /> describe� •. ,''�c�Y:�rs s :> �. .. ... .- . - ---• r. .
<br /> .. •• -
<br /> ' LOCATION ...................___ -- -......... - �����,�5 .. ._. -;.. . . .
<br /> JOB ADDRESS/, LGG.,� _ .�; x - "”- City p... _.._.._
<br /> r� � ._ .... r.�X97
<br /> f LOC A
<br /> �^ �lU 1 .... .. -•
<br /> ,., �R�Se ....... _ ..
<br /> v 1 hone,.
<br /> Owner s
<br /> Nam '
<br /> Address 1�>4_ -CP? - _...._,,. Lic., s
<br /> tice P one .
<br /> ik Trailer Court '❑
<br /> "- Conimercra'� ]
<br /> p.•iarccs ant ayse raster C t .
<br /> Contractor's Na � artm H
<br /> --- -iT. aur- s...
<br /> C:vnxrr)C OT $�q me
<br /> Residence i rpc.trr,e±;t douse' ,.rs,i'YV`�rcrdl [;
<br /> lnstallatron wr4� serve: s s' ,.r.: . Other - _..._..._ -� ........:...._.._.
<br /> ' Motel ❑
<br /> tris •��'''at:or�viil serve' Grinder .._....__._. tot Size --- -- ------�... . .
<br /> � Garbage Lot Size Private ❑
<br /> units:_...!°_�. . Number of bedrooms - Garbog, c-render
<br /> � )t rpr
<br /> ` Number of living ,e ,s •--....
<br /> t�. -•c-x--:�-.-•• Clay Loar�ri'�
<br /> Sandy Loam ❑ l r
<br /> Pubic System and name ............. Peat"❑
<br /> Water Supp Y, ry no ne Silt❑ Clay.. ❑ s v Lo�srrs f-' k3 .bor --
<br /> CFiaracter of sat tol dpt4i�of 3' eet: Sand❑ r C.cx r i ' ,, i' 'ayes, p
<br /> >>4t _ r c ❑ tY a _.._......
<br /> t'� of �,. .a Adobe ! Materia
<br /> .......... .
<br /> } ,, ..�;{.{., of ,,,,i clef I i` t Hardpan [� �� pill a; _ ' on reverse side.!
<br /> C " laced
<br /> i, .-etc. must be p
<br /> reverse sici$•1
<br /> ;... n� 0-
<br /> f public sewer rs dvarlable vert rn �� ot;'1
<br /> } SVS,es,-: i, relate cl i p res° {�t>sewer-is val m sst
<br /> t Ian, showing size of lot, location of system in relatiarti to wells, buildings,
<br /> 3
<br /> (plot p itlgri:r
<br /> s,x.e �� nor 4o.a sneer is available ..........
<br /> sl, tic tank or seepage p pP:ms�zed ,f
<br /> No sap ptjbl c -- . t
<br /> NEW INSTALLI�► li�+l: 1 ,, _ �, �, ,. ,st p r
<br /> , rr
<br /> u�d R ant
<br /> p
<br /> "TMENT }
<br /> SEPTIC TANK ] telomparfr' s
<br /> Gl:'-TRE $ire. ....- - •--•- � -
<br /> PACKA' S�.FTrCT 'f"!C i ' p
<br /> Material
<br /> fw v i Tye - ._.
<br /> opacifi . --- ,.r<Y ma,er_rilFovndation _------------
<br /> ------
<br /> top line
<br /> Na Ciirr+i?
<br /> nearest 9. acli line... J ng�h E
<br /> 1Vell
<br /> a ,,,c.t•� �. •- -- Total Le ...............
<br /> .
<br /> Distance to
<br /> — ._--
<br /> .
<br /> LEACHING LINE ":"......._--.-�-- ..... ken th of
<br /> ;No. of lines .-
<br /> [ 1 ,
<br /> T e Filter Material .......-.- Depth Filter JMaterial Line • -•
<br /> YP Property
<br /> t D' Box .. - Rock Filled yes ❑
<br /> Distance to nearest: Wali ......
<br /> ...... ....•....... foundation-,. .�_-_ I.
<br /> No
<br /> Diam ---------
<br /> z
<br /> SEEPIT ,�;•,�-• �---•--�•
<br /> _Rock Size ._ . a
<br /> ph .
<br /> Prop Linee ......................
<br /> ---.....
<br /> Water Table Det ;moi �'Foundation � :_..
<br /> Distance to nearest- Well -----
<br /> :
<br /> REPAIR/ADDITION!Prey. Sanitation Permit# •---• Date ---------------- -
<br /> r$ tf�r-SSS. ........................:................ ................
<br /> Septic Tank (Specify Requirements} .:._.. {��
<br /> !.... . ......_..
<br /> *cif Requirements] ---•----.��-s'.y��� ---•---- �---•---�........ ....
<br /> Disposal Field (Specify ....._.. ,�. ------------
<br /> ry 4.:.;t1
<br /> I
<br /> ---_-------------
<br /> '.IDraw existing aril required addition on reverse side]
<br /> i that I have work will be done
<br /> prepared this application and that the
<br /> Joaquin Local Health District„Ho*ce towner or ice'
<br /> I hereby certify
<br /> County Ordinances, State Laws, and Rules and. Regulations of the _.
<br /> I ---- " '^ arson in such mnni
<br /> sed agents signature certifies the following:- --- �”' permit is issued, I shall not employ any p
<br /> ,,I certify that in the performance of the work for which this p '
<br /> as to become subject to Workm n's:Compensation laws of California'"
<br /> Signed ..............
<br /> �... .
<br /> I - ---•--•--•--•---------------- Title .
<br /> By (If other than owner)
<br /> FOR DEPARTMENT USE ONLY
<br /> __. DATE -
<br /> -- -- — r
<br /> APPLICATION ACCEPTED y:........... .. -----------------------------------------.-.... .....................DA ..._... ....:.-_..._.._.__.._ ...
<br /> BUILDING PERMIT IS _
<br /> ----------•----- ...............• .................
<br /> ADDITIONAL COMMENTS .................. ......_.--•--.•---•
<br /> i ----------------- ----------------- ............................. ------ ._..... - ..._..................--.-.---------- ---..........
<br /> .
<br /> ........._. _... � ------- --------- Date ._..1. ..:--•••
<br /> ------------- ------- -----
<br /> Final Inspection by: ..................... .. .
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> 7 7
<br />
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