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FOR OFFICE USE: APPLICATION ICOR SAI�IITAT1ON PERMIT <br /> �,�... nhII �M Permit No.1��.�•7 .... <br /> '" lGoplete indpllcatel <br />....................... ....................................� t i� - - . _., .•oath Issued :-�:::�7=�:� <br /> . This Permit Expires t your From onto Issued <br />................................................ r <br /> l the- <br /> to <br /> Application is hereby made to the San Joaquin Local�iWhe Cou D tQ d narncae permit <br /> and existing Rules tand Regulat ons�ei» <br /> described. This application rs made in compliance i <br /> el&_A�. .0ENSUS TRACT .......... <br /> •.... <br /> TION .. <br /> JOB Al3DRf55/L - `J ��./~ .'..... <br /> k. ' Phone 7' i <br /> Owner's Name ( (,g ' .............. <br /> -city - <br /> Address I <br /> ' vr <br /> License .1..•- Phonea. I <br /> Contractor's Name _. �• .... <br /> .. <br /> ... I_-.�...... <br /> Residence Q Ap ment House(] Commercial oTraller Court [3 <br /> installation will serve: F <br /> ! Motel ❑Other.--•• •-•-•-•••. ..... ................... Gam.. <br /> _:- Number of b Brooms. �bage Grinder .. <br /> ..._ tot Size � ...................-. , <br /> Number of living units....... - io r.�l ��I... ..� Q.5.... ..4.-.................... ....Private© <br /> Water Supply: Public System and name .............a_ ---- 1„” i Clay loam ❑ r <br /> u, [3 Sandy Loam 0 y <br /> Character of sail to a depth-'f 3 feet: Sand b Silt Q Clay{p Peat <br /> Hardpan Q Adobe 13 Fill Woterial ............If yes,type ......:........ ............. . . . <br /> J' h <br /> v Ak <br /> (plot plan, showing size of 'lot, location of system in relation�,!tol�weils, buildings, etc. must min 240eon <br /> ; reverse side.} <br /> NEW INSTALLATION: INTI septic tank or seepage pit permitted! if ubllc sewer is available with ¢J_•- <br /> Sizer <br /> . Liquid Depth <br /> PACKAGE TREATMENT j j SEPTIC TANK I ] ... .. <br /> -• T Material www.•• No Compartments <br /> cc,pacity Type, <br /> G ...... <br /> tf I',[!_1 .Foundation ....c .---...... Prop. Line .., <br /> Na� of LenesDiponce to nearest.._Well b�he_�__ �i ��. - ..... Total Length ���.-•- <br /> !� Length of each line....--- .. .. <br /> LEACHING LINE [ j g <br /> I i �f �` ........... <br /> . . ......... <br /> �.� _&.De th Filter Materia) .._._...1 .....- . <br /> '[) Box ---.I..... Type Filter Material i . p .` <br /> �.. foundation Property Llne ... o <br /> s. . <br /> Distance to nearest; Well do...G?��j-..: ... Rock Filled Yes ❑; C] <br /> T <br /> SEEPAGE PIT { j Depth Diameter I:--- Number .......................••ql I: _ <br /> Water Table Depth ... :.............Rock Size ...---......._......_. - ._. ..:... 000 <br /> 00 <br /> ...Foundation Prop. ine ................ <br /> = P L <br /> Distance to nearest: Well •---•-= i- } <br /> I , <br /> ......... <br /> 4110 <br /> REPAIR/ADDITION#P <br /> rev. Sanitation Permit# F-------•= Date .....---••--•---••--- <br /> 1� --•-----............. .......... <br /> ._....__ <br /> Septic Tank (Specify Requirements) ry <br /> -.. -------------- ••----...... ? a ----••-•--•- --...----- <br /> Disposal Field (Specify. Reauirern11. ents} ------•..__....:....................... ..... <br /> --- ------- ------ �. ....................... . <br /> �� <br /> --- j <br /> '-"--"-"-;'---------'-- • I� (Draw existing and required addition an reverse side) <br /> I fiereby certify that 1 h lave prepared this application and that riflhe work will be done in accordance hsriih San Joaquin <br /> f County Ordinances, Stat�`Laws. and Rules and Regulations of the San Joaquin Lotat Health.District. Hance owner or licetw <br /> I sed agents signature certifies the fallowing: - I erson:in such manner <br /> "1 certify that in the perFormance of the work for"whicfi this permit it is issued, 1 shall not enhp oy any p <br /> i as to become subject to Workman's Compensation laws of California." <br /> h p <br /> ,f <br /> G Signed - Owner <br /> -------- ------ <br /> BY -max �._ �_. Title <br /> Ib ------------------------------ - <br /> lif Other than o nerl <br /> FOR DEPARTMENT' USE ONLY <br /> APPLICATION ACCEPTED BY _._.- <br /> ... • ------ -----..DATE . .. , ------ <br /> {� ��-----=-=------=-------------._.---•.,_.....__DAT .-.._._...- .------- ----•--••--•�-- <br /> # ------ <br /> BUILDING PERMIT ISSUED _.. li.............. ----------------•------ :-== <br /> ADDITIONAL COMMENTS ---------------- <br /> I. .__.: --•----------------------------------- ------------------- --•-�•--•---•-•-......-- .....__: <br /> .... ........... <br /> ------------------ •----_.._..- '------•----_� . ... <br /> l . -----•• --- <br /> �l --•-- <br /> Final Inspection b :._.!_ Da <br /> EH 13 24 1-68 i3e�. 5M SAM JOAQUIN °LOC,AL� H LTH DISTRICT c,13 <br />