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<br /> rF}y 5, FOR OFFICE USE:
<br /> r APPLICP,TION
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<br /> SA TATs 01 PERMIT
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<br /> -••-•-•••• .............. ., Thls'Prrmlt Explrrs'J Year From bate issued �•� f-•7!„
<br /> Application is hereby made to the San,ioaquin local Health District for u permit to construct and Install the work.hen n
<br /> { described. Thts application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulationsr ' E;
<br /> { ; JOB AL�bRESS/LOCATIO .....r�°.7 L... '..../ ...-.. ....... . ... ......................CEN5llS Tma .............t C:...
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<br /> Owner's NaM 1 Phone ..... ... .............. .
<br /> 1_'P441,I Address ... . .. ._f�..7. 7: . ..1r.�.. /.-���. City i ,. :.....................
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<br /> ' Contractor's Name .-.......: 1a.. 19.. ... !�r�.C:. ?....License <,C�c9�s�......... Phan!`.................. .:.
<br /> «y �`4 ? Installation will serve: Reriderrce:0 Apartment House(] Commercial 21'raller Court i]
<br /> Moml Q Other ... ! '
<br /> Number of living units•.....-..:... Numlx:r of bedrooms r Garbage Grinder lot Size ...:. ..
<br /> Water Sc' i Public System and name ..............Prlvcita
<br /> pF'y: y ..................................._.._........._..._..._............_............ .
<br /> Character of soil to a depth of 3 feat: Sand 0 Silt❑ Clay Q Peat❑ Sandy Loam( Cloy Loam © �•„ .•� �.
<br /> Hardpan Q Adobe ❑ Fill Moterlol............If yes,type............... ............ ti,
<br /> r�4�i)�M1Ai1. mro..rr�ur��ouo�sn_�w 1
<br /> ti�nt .r h• (Plot plan, showing size of lot, iocotiorr of system inrelation to wells, buildings, etc, must be placed,on reverse >iide
<br /> NEW INSTALLATION% (No imptic tank or seepage pitpermitted if public sower is avalluble within 200 feet,)
<br /> PACKAGc TREATMENT SEFI"iC TANK 5ire................. Liquid Depth
<br /> ....::.......... £x;
<br /> .......... "Capacity Type Materal.............. . Ni. Compartman . p fi
<br /> Gepp..Ya' Distance to nearest: Well ....................................Foundation .....- ......... Prop. line .. .+J
<br /> fir✓
<br /> LEACHING!WE ( � No. of Lines ........................ Length of each line.... _......... ......... Total length xt
<br /> Pox ...... ..... Type Filter Material ....................Depth Filter Material ....... ........ .. .....
<br /> Distance to nenre�.t: Well ........................ Foundation ........................ Pro parts l.lne .............. �
<br /> y �+a SEEPAGE PIT [ 1 Depth ........ ......... Diameter ................ Number ............................ Rock FIllecf .Yes Q NotCE
<br /> Water Table Depth ...................:............................Rock Size ................................ 1
<br /> Distance to nearest: Well ........................................Foundation ................... .Prop.-Liffe
<br /> -REPAIR/ADDITION(Prey. Sanitation Permit-# ............................................ Date ..................................
<br /> of�� Septic Tank ISpecify Requirements} ............... ................. ........................ ... 7
<br /> "R4*`rp�{ rS Sol elcl {Specify Requirements) ...�.. ��e�!r�F..�J`� r�{r�t ....
<br /> rr�.I re... .�r�.�! ��'
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<br /> fi .7 ' U (D w existing and
<br /> required ti
<br /> on on I hereby certify that I have prepared this application and that ilhe work Twill beeverse doneIn accordance witlsxSanfvl nf�
<br /> County Ordinances, State Laws, an:f Rules and Regulations of the Sas Joaquin Local Health District.Hem*owner,or
<br /> •'
<br /> sed agents sigioatum testifies the frilowing:
<br /> j ,\11, -"s; certify that in the parlormanc3 of she work for which this permit is issuarl, I ,shall not employ any person in such iiantier
<br /> r 1 as to become subject to Wnr'.man`s Compensation laws of California."
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<br /> . .�..) ' Ownergb .:. _
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<br /> t , By .............. - - ......... � ....----.. ......... Jitle � ............._.....
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<br /> 1,+rt p (If o'!:er than owner)
<br /> i` FOR 01:PARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY.,.... ......... .... .......... .... GATE,
<br /> `gat BUILDING PERMIT ISSUED ........ . ........... .................. ......................... . ... .. .........................DATE ;........ ...:....` .............:.:
<br /> ADDITIONAL COMMENTS ............................................... . ........ .....I. ................ .....................
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<br /> ........................................................ ......................-...-........ ........I........ .......... ..-.........
<br /> Final Inspection by: ..._........... ....: � ry........_..._.. ..... ................... .............._...........................Date .. ..
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<br /> EH 13 2It 1-58 Rev. 5X SAN JOAQUIN LOCAL HEALTH DISTRICT 3M .
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