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<br /> FOR o�rl�e use: � �
<br /> AI� .i�ATiJ:� E 51�,�iiAaION PERMIT
<br /> Purmit No.
<br /> (Complat*In Triplicats)
<br /> r This Permit Expires t Your From Date Issued
<br /> 0:+te Issued
<br /> Application is hereby made to the San Joaquin Local health District for a permit to construct and in;tail the work herein -
<br /> f described. This application is mane €n ccmplionce with County Ordinance No. 549 and existing Rules and Regulations:
<br /> JOB ADDRESS/LOCAJION .fin f./',S . . .?`1111 r' ..,". '" ` ' 1 CENSUS TRACT ... 1111...... .........
<br /> Owner's !Name ..��".a�'...G=C . �rj "' t:1111,.. �•
<br /> ............ ........ .. Phone . .... . .........1111...........
<br /> w
<br /> :..
<br /> Address .-... �- !ev .. "r n c. . fed'... }: .-1:111- 1111..-1 111....... .... City rr .'l�F... ... ....
<br /> .. ....1111-............. y
<br /> Ac
<br /> Contractor's Noma . ..- .�-w��- -�', �- '
<br /> ".:-•*Hearns ./rfa s� . . Phone :
<br /> Installotion will serve: Residence E�Apartrnent House❑ Commercial ❑Troller Court 0
<br /> Motel L Otta-!r 1111 ;
<br /> Number of living units: GY3 ;
<br /> ...1.. .- Number of bedrooms .....Gartaage Grinder . Lot Size 1111.. ........ ... ..............1.111 r
<br /> Water Supply, Public System and name 1 11 1....................... .................................................................................Private [ -g
<br /> Choracter of soil to a depth of 3 feet: Sand❑ Slit❑ Clay ❑ Peat[_1 Sandy Loam e Clay Loom ❑ r; "
<br /> Hardpan❑ Adobe ❑ Fill Material If yes,type
<br /> 1111-1111... ....................
<br /> f (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.)
<br /> KEW WSiTAi.LATIOM fNo septic tank or seep ge oit permitted If public sewer is available within 200 feet,} t
<br /> PACKAGE TREATMENT [ � SEPTIC
<br /> T Size. ?. A�. .rC_ ........ . ........ Liquid Depth .�.._._....-._.........
<br /> boa Compartments o ... No. Corn -._.. F •;
<br /> Capacity �.rP, -.. P�4ctha.rai...!� "!� ..ts
<br /> f� r
<br /> r Distance to nearer,: Well ........ ...........Foundation Foundation .......... Prop. Line .........
<br /> 1
<br /> LEACHING)LINE No. of Lines . .--•--�............. Length-of each iine,..,. iPA..'..._.... ....... Total Length —AlYQ.......I.......
<br /> O' flex ..y .. -. Typ® Filter Moherial ........ ..►. .....L3epth Filter Material .........................
<br /> F Dlitance to nearest, Well ...... ...:......... Foundation '
<br /> 1111 L9........-11.11. Property Lino .,,.5'................... • ,��„4,.,..
<br /> SEEPAGE: PIT [ j Depth ...... . Diameter ........ Number . .......... ... Rock Filled Yes ❑ No 0 ?i
<br /> Water Table Depth ............ ...............................Rock Size .......... .....................
<br /> Distance to noamst: Well ........................................Foundation _...-_... .......... Prop. Lina ...................... r '
<br /> RIPA2/A00ITION{Prov. Sanitation Perrnit^4 ......... ...:. .............. Dans j '
<br /> Septic Tank(Specify Requirements) .. ........ .............-.......................................................--..,_..........,.....,....................
<br /> ' .............
<br /> Dispdmp( Field iSpucify Requirciments) ......................................................................:...............:......................................11.1.1..
<br /> .................. . ............... .......:.....,.... 1.1. 11- •-' •- •-•........................• - 1111..-..-....._...... k
<br /> ................... ................ .. ..1111 ._........... ........................................ r ;
<br /> (Draw existing and reclulred addition on reverse side)
<br /> I hsreby cmrtify that 1 have pre7pcarod this itipplleaaslon funs! that 1ho work will be dote* In accordance with. son Joaquin
<br /> County Ordinances, State Laws, and Rolt-v and Retpulcaeloses of the San Joaquin locant Health Distrlct.Home ownor or licen-
<br /> sec!atgorats'slgnature cortiflas the fcallovwirr,: 8 ;
<br /> 1 Certify slgot In tiers performance a4 ileo wor4 for vvh;eh thle permit is Issued, I aholl not arsaployp any peraa n In such manner
<br /> toss to boa:ostne wbius:t to Workman'a Compenttatins, lags of California.”
<br /> Signed . . ...................... ....... Ownor fur
<br /> G .... ..... 1111-1111..-1111
<br /> � 11.11 ...
<br /> 1111...
<br /> By .... ...1111'. ..............1.111..-.. .L t!t'.-C.� _._ .' ,Is .....................
<br /> 1111..-... Jitlaa ......Qsr,•�i.(u. ��11_11-........... i
<br /> (if other than ownor)
<br /> r�
<br /> FOR DEPAKTisAENT USE, ONLY
<br /> .,;..,...�..�.�...�....,.,...,.+..,�,�......�.,..--1111, - �-.,�'.....,..n.....,�.
<br /> APPLICAThaN ACCEPTED BY -.�ti�r�'�-�r��._..............� . ......��.... R........111.1-11...............1 DATE � 'cv�.:�.� .. .... .-. .......
<br /> BUILDING PERMIT ISSUED ..................................... ...........................DATE ............................1......
<br /> 11-1111, e
<br /> ADDITIONAL COMMENTS . ...............................•..........................., ...............................
<br /> .................... .....1111.._-1111........ ' --.......-...-.............1111...........---.. .... ..........
<br /> ............ .... _............-...._-.....--.-............_ ....1111
<br /> ...... ........... ...........1111...... .-........-.........-
<br /> M-._ .. .
<br /> ......................... 1111...-_..--
<br /> --• ..
<br /> a�
<br /> Final Inspection by. .- y� -f a ..-.. Oafs .'r -.��� .. .......
<br /> SAN JCAGii N LOCAL 81-ALTH DISTRICT
<br /> E. H. 9 i 'G® rev, 5M
<br />
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