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T i <br /> FOR OFFICE USE; <br /> 1'; r A"UCATiON FCX smtTAT'ION MIT <br /> •• ... .. ..... .. Permit No..l...i .Sw�L..4f •nW, l <br /> E, ,* �}1 t�r?J fCanplese fa TrlplSsate) <br /> a , <br /> *r Daft Istued <br /> ....... ..... ............ TMs nett)))/ilse'lsee I Yeas Fra+ssl fSaMiseet!e�i A <br /> Application is hereby mode to the San Joaquin Local Health District for a Permit to con:fnict and install tlfea`,tMefUcj , <br /> described.This application,is made in compliance wilts County Ordinance No. SAA and existing Rude:"and RiQv�d101Me <br /> 9 JOB ADDRESS/LOCATION 7_10 <br /> Owner's Name ...........I..'.1— ...11....... ..... .......... ... .. <br /> :. Address ... ........ 7101,...E ..sM City . ` F <br /> ztr. �t Contractor's Name ._........ ........1�� ..f .. .f" ..............r . ....License—��{ .......•..... .., .: .. /t10n! ' <br /> J <br /> Installation will terve: Residence House Coanrnercial roifer Cart <br /> 1� �3 Number of.bedrooms --- Garbogs Grinder ......... .. Lot Stse' w <br /> ❑ �> <br /> ' Number..of living unitsr.._. ., <br /> ' htrub.._....Wotir SuPPI r Pvblk SYshm ad name <br /> $O � Doom[� <br /> 1 <br /> s Character of coil to a depth of 3 feet: Sit❑ Clay ❑ Peat❑ Sandy Loom a Clay xw <br /> f Hardpan❑ Adobefall Misterial..... .... .tf year time <br /> ,.,. .�. <br /> (Plot#'pion, showing *[Wof of lot, location of system In re to walls, wer buildings, <br /> hl;W INSTALLATION: (No septic tank or seepage pit j46itted if Public seis available wNhin 400`feee l # {� <br /> PACKAGETREATMENT (J SEPTIC TANK t J S:20..: ... ...... ... .. Lf��d p� <br /> R <br /> Capacity Type ............ AAa?e+Ial .. No Compalrfr+jtes+fs4 .a <br /> Distance to nearest Well . ... �....�........ f ndawfion .ti r!oP Lktt <br /> 4' LEACHING UNE ( J No. of lines Length <br /> of e�adrr lino �rltpfh <br /> _ Alw Mme« . <br /> 'D' Boz ... .. ..... Type Filter Material 4� <br /> x Distance to nearest, Well Y <br /> Iled <br /> SEEPAGE P!T ( j Depth ... Diameter Number <br /> ! .Iii! - <br /> G Water Table Depth ..... ,y <br /> s , .FoundotibA 'hL", t <br /> Distance to nearest: Well <br /> �.a <br /> yi l <br /> ay ►AlR/ADblfidN( •`,Sanitation sec <br /> Permit ,.� <br /> .. ..Q.. d Jet <br /> Septic Tank (SpecJfy Requirements) . ... .. � �.X�:.•v.'�•"•• Y :. ' 'Y <br /> �. <br /> Field Specify 1tv <br /> Disposald ! Requ!rements <br /> i <br /> h <br /> W _ _ ............ <br /> .. .. <br /> _ ....... E ... <br /> r C r Y4 f,rdr, <br /> (Draw existing and required addition on reverse side) y <br /> Vt I`hy;�;Jitify that 1 have prepared this application and that Else week will be s4e�se {n oaerslwteas <br /> z ;`Ceyjs�jr'Ordinances,,State Laws, and Rulss and Regulations of the gars Jeoq <br /> vih local He" Diekitt Herne owner M:Meas `K <br /> t z �� A✓ 1 <br /> sed ogents signature'cefttfies the following: e, r <br /> I cesti tha►.in the performance, of tfie work for which this persnif is {sesad, l s earl wet essspdey asty'e/sMe M>f �, <br /> fr` r <br /> as tobcome subiect to Workman"s Compensation lows of California" 'y <br /> .... Owner , <br /> j sx Signed /_ . ., M�+tv�R <br /> Y <br /> �f <br /> `.. <br /> ------ <br /> Title <br /> (if of er owner) <br /> FOR DEPARTMENT USE 0 Y <br /> �m.�... ,s _ � <br /> APPLICATION ACCEPTED By — 6✓�G / >!I. ...G4t—� DA-,E �,�j <br /> T�' f S <br /> Ddir <br /> BUILDING PERMIT ISSUED . . _ - <br /> ADDITIONAL COMMENTS .. . ... . ...........:.......... •••.. <br /> ........ .. <br /> r� . =t <br /> . . . ... . �.. . it /. . .. . n::!r > - • <br /> Final Inspection by: .. .....: <br /> � .. fir- —--t' <br /> F:H 13 2L 1•-6r) !2�v. �1 SAN JOAQUIN LOCAL/�f{EALTH DISTRICT e,/7t 3,M <br /> 1 <br />