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FOR OFFICE USE,
<br /> APPLICATION FCM PERMIT
<br /> ._ ._. (Complete I.,'g.IP{tf44+pMe9 Permir No. ......... ... ./
<br /> ...................... .................................. t
<br /> :. ^:.. Date hived
<br /> ................ ................................. This Permit Expires Yar'ffi J,D�6le hsued
<br /> Appl c, ;on is hereby made to the San Joaquin local Heall. DI(;i rr;y'permit to construct and Install the work herein
<br /> dost :Fed This a, liec.:lon is made in eompli hce with County n:lJo. 549 and existing Rules and Regvlations:
<br /> 14 7
<br /> IOB AuDRE55 ION C-?� L�tt' CENSUS TRACT
<br /> (� /r
<br /> I , "G: '? I/ �E`�•PT:t'r-v.L�•.:...:.,..yL<.. i.�y/,�� ,�` r!- .,.. r. 7._?.. ...�-Phone .. .. ...Owner's Name
<br /> Address ... .......
<br /> ..
<br /> _./.
<br /> .
<br /> Contractor's se l�/ jPhone
<br /> Installation will serve.
<br /> Residence[]Apartment HOUN +�'rtla; raller Court J]
<br /> Motel Other._. __. .s `
<br /> Number of living units:.. ......... Number of bedrooms ............Gawe'y' •,yiirider •Lot Size . ...� .}"�k....-••••�
<br /> .._........ /
<br /> ...�.,,.: . ...........Private❑
<br /> Water Supply: Public System and name ........................ ..............'.::, �. ; ,. __................. . . . . . ........
<br /> Character of soil to a depth of 3 feet: Sand{] Silt❑ CID;," �W�Cpr`Q Sandy Loam ❑ Clay Loam (� �
<br /> Hardpan Q Adobe Q, .1:114 0 ... If yes,type...............
<br /> (Plot plan, showing size of lot, location of system in relation buildings, etc. must be plead on reverse side)
<br /> NEW INSTALLATIONt (No septic tank or seepage pit aernflnoo ' �e}j'.Ik.`sewer Is gMMvailoble within 200 feet,)
<br /> PACKAGE TREATMENT ( ] SEPTIC NK{ ] Size,' ' � .. ,.�W.....-..... Liquid Depth . �.... .............
<br /> C
<br /> 0 .. .. No. .Comoartmentr .. ............
<br /> Capacity/ ''L ..... Type 4ii. "�.0 . ATFe')I" 'Co..
<br /> Distance to nearest, WellAd)6.. ' �:=. .•Foundationm. .. ......... Prop. Line e—c...............' v
<br /> LEACHING LINE [ ] No. of Lines 1,r........... Length of e>a ,4>isa S... .. . _..... Total Length .y:C...............
<br /> 'D' Box . . ... Type Filter Material r Depth Filter Materlai .:Q.....................................
<br /> .'
<br /> Distance to neorlst: Well .._... ..... #��ti'd�t bn .. . .._. Property Line ...... ................�
<br /> SEEPAGE PIT ( J Depth/. ...;.✓ ..... Diameter .. IdgAa'Isfi, ,J.V- . ... Rock Filled Ye> No
<br /> Water Table Depth ................... ..._.__ -. Rock Size -......................_......
<br /> / y�
<br /> Distaxe to nearest; Well .,
<br /> �./,..ff... +•.. '. Foundation .................... Prop. Line ........................
<br /> • REPAIR/ADDITION(Prev. Sanitation Permitsk........_..._... ...... :'D"ata .................... .............1 -
<br /> Septic Tank (Specify Requirements) _._.. .................._. :....... :i..:f _ . ... ... ............................................._.._.............
<br /> Disposal Field (Specify Requirementsi ............ ......_........... . .,...-'�.'• ... .. .__. _... .... ....................................................
<br /> ..................................
<br /> r
<br /> (Draw existing and requued h.=;%TiVA c)n reverse side) +
<br /> I hereby certify that I have prepared this application and thdt hMM"AOv'', will be done in r ccordancs with San Joaquin `
<br /> County Ordinances, State Laws, and Rules and Regulaticm of_H,�$:$re'm'-Joaquin local Health Dlstdct. Homo own" or llcen•
<br /> sed agents signuture certifies the following: •'
<br /> "1 certif, that in the performance of the work for which this pAriAYY:W; laved, I shall not employ any person in such manner
<br /> as to become subject to Workman's Compensation laws of Ca like
<br /> Signed
<br /> BY
<br /> p other an ow erl
<br /> i
<br /> PAR MENY 90'1QNLY
<br /> APPLICATION ACCEPTED BY --�- � 'r ,fill -� .. DATE
<br /> BUILDING PERMIT ISSUED
<br /> ADD[ypp�q�,�QMMEry :} ' f 9},�,
<br /> IAJULa.4,.cvs. . ,7 bc. .a. �,a,JliJ w-f1+�v Iii' ,M,:,y�'1'v.a. V—
<br /> Y,
<br /> . 1 faY1 rd'A,'YIELL 2! t�'.' H y. fr -Cyto' 11k�v.•(n"rrv _Y.(13 �{ .n
<br /> ;r.�^'��'-�•"Qvh i As W.k
<br /> Final Inspection*by: •1 IC`�'JCh'�,\. Stvv�. CA L\.
<br /> 1 �,g . Date ' i -f
<br /> E 13 2L 1-61`1 Rcv. $H UU SAN JOAQUIN t- CAI Nis�a•61'Fi DISTRICT 8/7h 3M 7_ F
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