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NITATION PERMIT <br />.�. FOR-ol"FiC.E-115E= APPLICATION <br /> FOR SA <br /> Permit No. . .....:=-._:....... <br /> {Complete in Triplicate} i <br /> Date Issued ................... <br /> k <br /> . .................. ........... ............. • This Permit Expires 1 Year from Date issued <br /> rmit <br /> all the Work <br /> Application is hereby e+nade to the San Joaquin Local Health Distrlr�inance for a No. SAto enodnexI <br /> s trn� Rulestand Regulations,ein <br /> described. This application is made In compliance it County f <br /> -7 ..CENSUS TRACT ......... <br /> pCAT ON ..- , .Zoo2-,�. .................... <br /> . ,.Phone <br /> JOB ADDRESS/l _... .. .__.. , ......_:... .................................... <br /> Owner's Dame City ........................................................ <br /> 5�: t _. _.. .. ...._..... �� Phone . �� /. .. <br /> Address .... ..License # 1 <br /> ...................... - <br /> Contractor's Name •- <br /> 74 ' Apartment House❑ Commercial❑Troller Court ❑ _ ' + <br /> installation will server Resldenoe p . _-- <br /> Motel ❑Other rte, _ •--- • - �-- <br /> _. Size ...._ ... <br /> _ � Garbage Grinder Y - <br /> _. _........... Lar <br /> -Nurn6r of living unite:. - -• plumber of bedrooms --- •.••_.. ..........................•--............Private,¢ k <br /> Water Supply: Public System and name _......................----------------------- <br /> Character of soil to a depth of 3 feet: Sand T3 Silt❑ Cloy ❑ Peat <br /> ❑ Sandy LOOM ❑__._ �aY.Loami <br /> . <br /> Hardpan[3Adobe❑ fill Material .............If yes.type <br /> tion to wells, buildings, etc. must be placed an reverse side.} <br /> IPlat plan, showing size of lot, location of system in tela <br /> it permitted if public sewer is available within 200 feet,l s <br /> No septic sank or seepage p , �x Li uid Depth ... .........•......� <br /> NEW INSTAIIATIONs { p .............. q <br /> ize. . ...1.......... ...... � <br /> PACKAGE TREATMENT { } SEPTIC TANK . No. Compartments -••-�-••- <br /> Capacity ��aQ-... Type .�•- •- <br /> . Material.4- ..... 10' <br /> [' <br /> Foundation .............. Prop. Liras _.. .. '..f.. ....V <br /> Distance to nearest: Wein .- Q ............. .. i <br /> . Le 4th of each line. -•.... ...... Total Length �, �*1••............ <br /> :EACHiNG LINE �` No. of lines .-.... n SIN .Depth Filter Material . .{•�......................... � <br /> 'D' Box ............ Typ_e'Filter Material f... -........... <br /> Well ., ......... Foundation .d <br /> ............. <br /> Distance to nearest; .. <br /> Number <br /> umFilled Yes NO <br /> SEEPAGE PIT } Depth -.-'e........... <br /> -D}omet ..�..... -----• b..Rock Size .��yd.. >. o ? <br /> + Water Table Depth ---...... �...� A f34..... Prop. Line „ . ........ <br /> We - �_ -.Foundation <br /> Distance to nearest: 11 ...,T...._::_-.----------•-�----I } <br /> ' rev. Sanitation perrr►lt�# ............................................ Date __......-............ .......... <br /> REPAIR/ADDITION lP ....... ............................. .............---......... ....__......................... ..........• ....:....... <br /> Septic Tank {Specify Requirements} _ .................................. .... <br /> ..............................I............................. <br /> D�sQosa4 Field (Specify Requirements) ........................................................... <br /> .. ....................................... <br /> . ---- F............... `' .........:._......_........ .......-........_....................._........_...._....._... . <br /> - - -•--•- ------••--....-•---•-----•--......_.. ..... <br /> -----•---•--------... <br /> f ... {Dr`aw existing and required addition on reverse sl e <br /> I hereby certify that i haus pro this application and that <br /> with Son Joaquin <br /> t the work will be done In accord <br /> ► Y <br /> countyOrdinances, Stale flaws, and Rules and iiegulations of fire San Joagerin L`oial Health District,Home owner er icon" <br /> { <br /> sed agents signature certifies the following: ermit is issued, I shat! not employ any person in such manna; <br /> k "I certify that in the performance of the work for which this p <br /> ms ro t:e o su act toPkm ompensation laws of Call(Ornia.".. ---- ... Owner <br /> VHt <br /> --- .................... <br /> � - �� -•--...... Title •--- , .. .- . . <br /> E {if other owner <br /> FOR DEPARTMENT USE ONLY <br /> ! DATE . /Q.'...:.....:.. .........:-. <br /> i APPLICATION ACCEPTED B <br /> . ........ ... <br /> BUILDING PERMIT ISSUED ......................._........ . .............---.........._........._-....._......_-.-..-••---_....._....... <br /> • ............................. <br /> ADDITIONAL COMMENTS -..... .. -�....... ... ... . . . ...............-�... <br /> ----------- .................. <br /> ..... . - ........................................ ......... ....... <br /> -...... _ <br /> � . . ... ..... ............. -..-.• � ...�'-.. ............. .-...-.. .........-..... ...................-.......Date _ ���-=-��............ � <br /> " . 1 % ' <br /> h 3M <br /> Final inspection by: - ALTH DISTRICT ry" 8�7 <br /> EH 13 2h 1-69 v. SAN JOAQUIN LOCAL G <br />