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rL <br /> "�•� <br /> iE.USE: APPLICATION FOR SA PERMIT permit No -_7.2 02 <br /> rt tcomplas in Triplicate) <br /> Date Issued _!..-..'..._.... <br /> ---------- This Permit Expires 1 Year From Date Issued �.d � i� , <br /> -a }; "'' a Autos and Regulations: <br /> APPtication is hereby made to the son loa4 hence Counttytordinance npermit <br /> and existing °instdll the work erem <br /> described.Thls'apPlication is made in come •. <br /> �/ _04TRACE <br /> JOB ADDRESS/L ....... <br /> ___._._..__Clty =--f-•_'/._ _..__..•. ..... <br /> ` `i� - - Phone _-.._...-------•-••- <br /> ' Address .../4� -{ �' ............. _.._.License # --- --- <br /> -------- <br /> ..-__. ------`--------_._.._._.__._ ..----• Corettrlerciol❑Troilei Court t] j <br /> Contractor's Nam;._..—.__. mem HWO13 ; <br /> installation will server . Residence�Part <br /> M ' <br /> Motel ❑Other.............._. <br /> Oarbcge Grinder. ._- —tot Size .:r.. <br /> ._r <br /> - - Number of living-unitsi�:------.- Number-of-bedroom\ Private <br /> � <br /> Water Supply: Public System and name -----------.............•�...... Pmt❑ Windy Loom Clay Loam 0Clay ❑ <br /> i Character of soil to a depth of 3 feet: sand Silt❑ e _---------------- <br /> Hardpan❑ Adobe❑ Fill Material _.-..--.--- If Yes,h'P <br /> (Plot plan,.showirig.size�of lot, locatiod of system in relation to wells, buildings, etc- <br /> s, 6e placed on reverse side.l <br /> �� a it ermined if public sewer is avoitabie within 200 feet,) <br /> NEW INSTALLATION= {No septic tank or'seepa9 P P -- Liquid Depth --------------- - ' -� <br /> SEPTIC TANK ] Size-------•-_-______--- <br /> No. Compartments __-..—• -- <br /> PACKAGE TREATMENT 1.) Qt <br /> Material-----••-._..----_-_ op i� <br /> Capacity -;..........._..._ Type __ - Prop. _ 01 <br /> ---- ...Foundation._..-_. <br /> 00 <br /> Distance to rost:�Well_� t <br /> of each line---•--------_.••-.-•---• Total Length .... / <br /> CHSING UNE I 1 No. of Lines... -. Le^ Filter Material --......---- ........ --- ` <br /> LE p• Box Type Filter Material - D Property Line <br /> Distance to nearest: Well ......_.....___._- Foundation No ' <br /> Diameter Number -----•---••__-..._.__._ _ Rock Filled Yes ❑ <br /> SEEPAGE PIT 11 Depth "---"----'-"•""---- <br /> Rock Size _.-..____._----------- --- <br /> Water Table Depth ----..-__.-.-___-•-_.__._�.. ...-.._._ <br /> Distance to nearest: Well .._..-_._-__..__---_.--_---. -. Foundation •---------•------ Prop. t!M __....._.._._-•.� <br /> ' -�..a-�:•�.. t � -_ - pato _•--..`s�—_-..._:_..._ <br /> Rl PAIR/ADDITION(Prev. Sanitation Pet(lit# -------..'... ...... - - .... -----------_.._.____ <br /> !septian^_pecify Requirements) <br /> ®/� g/�__.w... ..... <br /> pisposal Field (Specify Acquirements) 1'�-�" ....._........ __.. <br /> ••�----•------•------------- ------------=­_­--------..-_. . -- -- - ...............—_..-_.. - ------------- <br /> -- •.. .......... - ._...........---- ------ --- -----'- <br /> • " (Draw existing and required addition on reverse sr <br /> I IherebY certify That I ihnve prepared this application and that the work will be done In accordance with San Joaqu n <br /> Chaws, and Rules and Regulations of the Son Joaquin Local Health Distrlot. Home owner or [[can <br /> unity Ordinances, Slate L <br /> - <br /> 4 sed agents signature certifies the following: ermit is issued, 1 shall not employ any person in such manner <br /> •'I certify that in the performance of the work for which this p <br /> I' as to become subiect to Workman's Compensation laws of CaUforni0a nor - <br /> a <br /> -._......... - ..---'---- <br /> By---.....__---•"jii- <br /> an owner) <br /> FOR DEPARTMENT USE ONLY l <br /> 1 DATE .Ile-.�_f�---73-_..._.-...._.-- <br /> J .. <br /> APPLICATION ACCEPTED BY .. _.-. —._...— - DATE .----------------- .— -----. <br /> BUILDING PERMIT ISSUED ------ ------------ -------------- --------------_'- _ -_....-...�. ..•-- <br /> 1 ADDITIONAL COMMENTS _..._ e._............... -........... -..._._ _. .••--._ - .... <br /> ----------• ---.• --- - ------------ - - ............. — <br /> _ - ... <br /> aft <br /> Final Inspection by: .__, - <br /> ! SAN JOAQUIN LOCAL HEALTH DISTRICT L. <br /> H. 9 1- <br /> 1` t <br /> E. '68 Rev.51114 <br />