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- • •••• ryp 4ANIIATIVI! PERMIT <br /> ' .F .. (Ceinplete to Triplicate) _ Permit No1�1, D�y <br /> '- / This ParmIPEzpins I Year From DaN Issued Date yv? <br /> Application 7s hereby made to the San Joaquin Local Health District. for a permit to construnstcll tfti warkr,t` Ji <br /> ^•„tY h : described The application iz made In compliance whcthCounty Ordinance No. Sd9 and existing Rutand Ias'and Ragulalloha <br /> JOB ADDRESS/LOCATIO�j �Q.: W <d <br /> I �L�.e_J ... ��� .. .CENSUS T� <br /> q° Owner's Name ( y� <br /> r f .t;s/t ... Phnne <br /> Address S_3,7� JL4...... y 4 t3 t <br /> Name <br /> ... �� Phone` art i.'s : <br /> ��_ /�d c � [Cit r(Lit <br /> rc}. <br /> Contractor's Name ... .. �{,.��I:4�e(� .:1e-z�kf.[. G. License # /��/ <br /> 2 r Installation will serve sidence(Z partment HoJse 0 Commeraal ❑T aIle Court <br /> .� +;. Motel [3 Other :_ ..... ___-'_ <br /> Number of living units ...... Number of bedrooms ': J Garbage Grinder .. mot Size 9_r A <br /> Water Supply: Public System and name .. .......... .: ................................... .._.... . _.._... ..::.. ,Private st , <br /> ? a t Character of soil to a depth of 3 feet Sand[] Sllt❑ Clay ❑ Peat[7 Sandy Loom r' Clay Loom,,,"}ya `v <br /> Hardpan ❑ Adobe ❑ FIII Mdterial _.. if yrs,type . ': ,„�, «•* <br /> ('lot plan showing size of lot location.of system in,relation to wells b0dings, et_ must be placed an reverta' sid•j -*X <br /> ' NEW IrlSTALLATION : INa septic tank or seepage pit permitted If public sewer is avca able.within 200 faetj <br /> ?ACKAGE TREATMENT [ ] SEPTIC TANK Size .:_.. ......_ Liquid Deth <br /> ' Capacity . ,___...._ Type ...... ..__ No 3vCOmpartmsnts <br /> Distance to nearest! Well ::. Y'Ab <br /> ............. Fcrndah>� ... Line <br /> LEACHING LINE [ ]:' No of Lines .......,. Length of each line _.. e-7ofol�L ` <br /> 'D' Box . Type Filter Material _... Depth F ire MaterialrN ”'*n' <br /> crAC.E ° ' r ' Depth .. Diameter Number <br /> Line.,.... <br /> r z <br /> Distance to newest: Well Foundation . Prep•-Line :: .... r <br /> 1 P Yaa p .z <br /> Water Table Depth .i. _..._, Ro K Si:e <br /> Distance to nearest: Well .__.. _. Fo �da'ion +'SSP Pr p` L • `.:... , <br /> o 4t <br /> REPAIR"ADDITION Sanitation Permit# ......... __. Date _.:. .... <br /> 1 <br /> Se:• clank (Specify RequuementO .. .. ....... 'r# �S <br /> r �sposaI Fi�Id IS cify RR,e�q�uiirrem Xts) CZ�/{J�/) �.�0 ' 4 -' +s-c- � ' t`rz°(, ,Fur <br /> be-te-H.A't 7" VV Q'3w•-rs.7 ..C1FL.-.�t.ar, ^{ ` r w' <br /> (Draw existing and required addition on reverse side e t •, {s At' <br /> d t <br /> 'I hereby certify that I have preparehis application and that the work will_be done In eccesdangJ wlfhz�t�LaY..a•"7•>At,Ipp�ufn7 `t <br /> County Ordinances, State Laws,-and Rules and Regulations of the San Joaquin Local Health Dlstdct L4W4,5YWll -v Karn es <br /> sed agents sicneture certifies the following: [ :'r r g .si p, fro <br /> r' <br /> "I certify that Imthe performance of the work for which this permit B Issued, I shall not employ any'penon In°►u li'e's <br /> as tobecome subject to Workman's Compensation laws of California." <br /> f �,,1 ��' <br /> S gned _. ...` Owner Lt fi #iT',�r+ ,' <br /> stiL <br /> -, BY -+✓ her) :. . . . Title . <br /> , w r <br /> owner) �„Xti titF <br /> FOR DEPARTMENT USE ONLY <br /> 'p APPLICATION ACCE TED BY '' {'r . <br /> DATE I/ � 7caL <br /> „s BUILDING-PERMIT. ISSUED ....._. :::: .. ::.. .DATE ... J•++�e <br /> ,... ADDITIONAL COMMENTS '. . :....... .... .. . . .. _ . _ ... ::. ...... rw -.'iu�7T, <br /> _.::: .... . .. ......... ...._._..._ _ +a� <br /> 9 ... ._.... .. . _ G' _ p y, <br /> ,y <br /> Final Inspection by ... 1. ?`."F.:u{ /kFLv-w� q'�-+�!e-c- /t`l d�._ Date �. if �y <br /> 1 i ic+ Ph <br /> .'" SAN JOAQUIN LOCAL HEALTH DISTRICT } ` l ' <br /> rY �' E H. 9 1•'68 Rev:SM '� c,.# <br /> n is i .,rzaiflsi 45'. <br /> ' <br /> , r <br /> WfrkU'._ . <br />