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FOR OFFICE USES -APPLICAU614 FOR SAfd'sTATION PERMErP74. — <br /> . _ errrsN Gla: ........... <br /> •••........... ................. ---- - Clete in Triplicate) <br /> ................. . (Complete Dote Issued ��:.F.....1.h <br /> T' <br /> This Permit Expires S Yrae Fr�arer Dete tined <br /> ................................................... <br /> Application Is hereby made to the San Joaquin Local Health DI51rlCt for a permit to construct and Install the wcrk Gserom <br /> desuibed. This opPlieatlon is made to compliance witls�Count� 0 9a /6° ti9 and existing Rule: and Regula/tio^s' <br /> .+ff11 Iv R CF.PISUS TRACE v 9a ............ <br /> 77 ._ .....:,�... ............. <br /> J08 .ADDRESS/LOCATI _L.7.6.d._�..r....7.l.Lsx'..� .........Phone .. ... ..... <br /> 1 Owne;'s Nume _.. ... . f� ../Lu�L'dLa......... -- ... .. <br /> ... ..:._.'76..0...7...6.... /1.lrr:.7;:�(.,./ t zy�Cl. -."....... . .. .. <br /> Address ..._..._....................... ........... _ ! N}S'D'rl... _._.. <br /> . ..........*................Licest"0 .......I............. Phew ..............._. <br />• Contmttor's Nome .. ...... .......................... . <br />" Resldenco Q Apartment House{] Cq^'nwrda!�Troilor <br /> Installotian will serve: -Yh,,,:f �'�'+��`• <br /> Motel❑Other.................. .... , <br /> Number ar tiring units:_ `._... Number of beciraans .:j.......Garboga Grinder ............ Lot$Ise .:...........'./..G,rhfate . <br /> u2_.. L�x:.£I�J.w{-f........... <br /> Water Supply, public System and name �Lbn.wa.->--. -C�•�...'t'�'R�E Sandy Loam 0 Cloy Loom 0. Character of soil to a depth i '-k; Sand❑ Silt C1 Cloy [.] <br /> tardpon[] Adobe❑ ill:Material ............If yes,type............... ............ <br /> (P3ot plan, showing r! 'on of system in rotation to wells, buildings, <br /> etc. rrn;st in platat' .^n rovers0 side <br /> NkV6IR5T3114ATIONs +k or seepage pit permist d if I>ublic sewer is avaclable within 200 fee*,! j <br /> q _ .._..._ ,C TANK:{a1 � .�x. J`_ ./4. ............... Liquid Depth .- -.�G......__. 6 <br /> .,_ n SGse... -- <br /> PACK;;GE TREATMENT ( j rtmanN ••_---•. <br /> Capucsry l., :.d C....... Typ ...iif y. Material. f':!.'k-......... ✓t. Compo <br /> rO '-Y .......Foundation Z-0!1........_. Prop. Lieu--. -. -.._.._. <br /> Distance to nearesb We., ....><t..". -................. <br /> Ler. of each line-._7�....... ......... Total Length -A�--10..........._ fq <br /> LEACHING_LINE No. of Lines .... .............. .. ti i . <br /> 'D' Box . Type Filter Material :•-•t-•-_Depth Filter Materiel -�-1..•--- "" <br /> ' Litur........_........... <br />' <br /> Distance to nearest: Well .,rV.�............... foundation ../Q............ ..... <br /> FfOpfl� r <br /> Z"mbar-............................ Ruck�fl4!ed'�Fes.•�j"_k '�^7 <br /> yeses.,.EaaSa.Gtgsth-................................... .. ..... _ <br /> prop. Line ..............._. _ fes, <br /> . FoaxtiFaNeer" , <br />:§ <br /> ................................ <br /> Sate...._...-.... ...... <br /> REPA:R/NGsiTION lPrevSanitatirr+ Permit .................................. j <br /> _...........--... <br /> .............................. <br /> Septic Tank (Specify RequkemeMsl ...........................................:....... .......... _ <br />.�.. . 13i Disposal Field (Specify Req+riraman4s) .................................................................................................................................. <br /> r <br /> ..........................._............................................................---................................ ........................ <br /> .....-- <br /> ........................ <br />}. <br /> ..-'.'--"""'"'.-"".."....1 - (Draw azisting and required ad'-Hon txf reverse i e <br /> I hereby certify thni I kava prepared this apPlicreSvI and that the work w311 b:r done )n a'lli d . 'drib" Sun or n <br /> Coany Ordinances, Stole Laws, and &alas and Re9vlations of the San Joaquin f.acoi Hera+ff+ Glstds.4.4iuma or'ner or tam <br /> sed agents siayatara certifies the following: any P arson Ix such mann.+, <br /> "1 "JIfy that le the eerformorce ofthework for which finis penult is Issued, f ,hail not employ <br /> as <br /> to berfb�i+n zublect jWWp�t-,-mary 7r toerpenfaHon laws of Californ':!" <br /> .*M f� (--^�.1.-..' ;"1tot............... Owner <br /> a Signed .1...�• . . ..] .. _ ........ <br />,r .... 71t1e ..._ . <br /> By .... ... .... <br /> ...... .... ....... . . <br /> hf other Iron awned <br />+' FOR DEPARTMENT USG ONLY .--����' <br /> TE �L' ...... .... <br /> t�xrf:........-- .....--'---....................._.. .......... ..._................. ....._..... <br /> .. <br /> APPLICATION ACCcPTEO BY �'+?"� .-,.-__ .. .....DATE . _. <br /> . <br /> BUILDING PERMIT ISSUED ���-� ��- �� �.��fly�.Q(,yO„4r.. ,,,.Jf.AG � /.ry�J�- �-- " <br /> AODITIONPI. (.OMMEhTS /�, ar�� <br /> �ie � tenet c <br /> .rte Grr Award ylG� �ri"Co...of.w'�s < <br /> ...4•... /_<<+r/rc u`xYrr�...... L Yrr� _ _ _ - Dat ..._.. <br /> e 7� 6 <br /> Final hup..•ction by: .. <br /> .f t_...... ... 8/7b 3M <br /> Ell 13 24 1-613 l3Gv SAN JOAQUIN LOCAL HEW" DISTRICT <br />