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PUK rxMu APPLICAMN FOR MWATION PERMIT ' <br /> :.... .............. ..... ^.._r....-....... Permit No. 25::~-. k. <br /> ICotnpleh In Tdplicatd <br /> ...... .. ............................... ............ <br /> 75 <br /> .........., This PerndtExpires 1 Year From Date Issued Date Issued ..5:.!�t. <br /> Application Is hereby made to Nte San Joaquin local Haolth District for a permit to construct and Install the work herein <br /> described. This application Is made In compliance with County Ordinance No. 549 <br /> and existing Rules and Regulations: <br /> JOB ADDRESS/LOC//ATgqION ..5. ' ..... ...�. _ ... �.cZ/................ ,4..... ......CENSUS TRACT ...... _..----------- , <br /> Owner's ......... ..._.. . ..................... ....... ...............Phone <br /> p}` .......... <br /> Address S'/� �. �r�....�.. 7— <br /> ...............................^-.•__.^.. ................ ................................... <br /> Contractor's Name ...... JSvt........................................................._..... ...... I nesse # ........................ Phone ......................._.... <br /> : <br /> Installation will serve, Residence Q Apartment Houseo ConwAfri lTraller Court ❑ <br /> Motel 0 Other---------............--------------...------ u <br /> Number of living units:.... ------- Number of bedrooms ............Garbage Grinder ............ Lot Size ..?.3�-----------._---_--:._-_- <br /> Water Supply: Public System and name ......................_._._..._._...._.....................-.__...._....-_...._.....................Prlvotio <br /> Character of soil to o depth of 3 feet: Sand]7 Slit o Clay It Peat 0 Sandy Loom jM day loam 0 <br /> Hardpan 0 Adobe Q Fill Material ............ If yes,type ............... ............ <br /> 'Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: iNo septic tank or seepage pit permitted If public sewer is available within 200 feet,► <br /> °ACKAGE TREATMENT ( ] SEPTIC TANK Size_3+f0.;. $r......................... Liquid Depth !..._.________. , <br /> Capacity ..hp.......... Type .. Material--- it-YP&...... No. Compartments <br /> Distance to nearest; Welt .... _ .tr <br /> .Foundatlon ._ �............... Prop. Lina .. ~ _._...%9' <br /> !EACHING LINE 14 No. of Lines .............. Length of neeach llne..... .........._...... Total Length <br /> 'D' Box .Yw..... Type Filter Material ..,/.r,.1......Depth Filter Material ../y. ........................._..... <br /> - . Distance to nearest: Well ..:70...........:..• Foundation ................ Property Line .'�It..........._... <br /> SEEPAGE PIT ( g Depth ... _... .......... Diameter Number Rock Filled Yes ❑ No 0 <br /> Water Table Depth .__...........................................Rack Size•.._............................. <br /> v <br /> Distance to nearest, Well ........................._.............Foundation ............._..... Isrop. Line .................. <br /> REPAIR/ADDITIONIPrev. Sanitation Permit# ............................_.............. Date .......____......_.___......,) <br /> SepticTank (Specify Requirements) .........................._.._..........._.._..-__.. ..._.........._......__.._.........._:»:....:...:...:_................ . <br /> Disaosol Field {Specify Requirements) ---..-......................................................_............._......................._.......:............. <br /> ....._� <br /> r- <br /> . •••••....................._._.. <br /> (Draw existing and required addition on reverse stde) <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordinances, Slate Laws, and Rules and Regulations of the Son Joaquin local Health District. Home owner or liter, <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit Is issued, 1 shall not employ any person In such manner <br /> os to bet a subje to o en's Compensation laws of California." <br /> Signed ..c ...... .. ..- .n.�.�,<...�............._..... Owner j <br /> By . _. ..... ......_...._.............__.. ....._.............__......._...............-..--.. Title ..........._....__......_.. <br /> (If other than o nor{ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BYI. _._................................................................ DATE . '/S.7f .....:..:....:.....:r: ; <br /> BUILDING PERMIT ISSUED .................................: ..................................................... DATE-.. ......................................... a <br /> ADDITIONAL COMMENTS ........... ....................._.............. <br /> .... ............_ . ...............------....................................................... ....._............ ............................. <br /> ... _ .......... <br /> .... .. ................. <br /> .. .. .. .................. <br /> . . ... ........... .... <br /> oio <br /> . ............ . ... .. ..... ....... . . <br /> --*... ... <br /> Finol Inspection by: .._. .- <br /> „/i'�/ - . ................................... .... .................... <br /> ......Dote .S::=:;?x:9..::7,7:.::•.•.:.•• . <br /> EH 13 26 1-0 ftov. 5?t SAN JOAQUIM LOCAL HEALTH DISTRICT 8/ 3P1 <br />