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ei3.4Abv <br />Date <br />8/7 4 3M Final Inspection by: , <br />EH 13 24 1-68 Rev . SAN JOAQUIN LOCAL HEALTH DISTRICT <br />Permit No. •-•? <br />D <br />This Permit Expires 1 Year From Date Issued 11 I <br />ein <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work <br />Of <br />described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 'CENSUS TRACT <br />PhOne g..?3— 5/0 <br />........ .... t <br />j _ <br /> License #.1. 'Phone . <br />Private Et <br />Water Supply: Public System and name <br />Disposal Field (Specify Requirements) <br />(4 <br />1 <br />_ A.p,\ <br />FOR,03EPAKTMEN '1JSE, ON <br />APPLICATION ACCEPTED BY <br /> DATE <br />BUILDING PERMIT ISSUED <br />‘N,1 <br /> DATE <br /> <br />ADDITIONAL COMMENTS <br />APPLICATION FOR SANITATION PERMIT <br />(Complete In Triplicate) <br />E..012 OFFICE USE: <br />JOB ADDRESS/LOCATION ./e2 , .5.-./.' ol <br />Owner's Name .5"'"reVe--"- I ,...5-egellie' 5 <br />Address 1 1/..7.67:71 ... .5", Aei_.,Z7)12 <br />Contractor's Name .4_1_,Z, fr".7-4•.•ZZ,6---te. <br />Installation will serve: Residence (20 Apartment House 0 Comrritigal Orratler Court 0 <br />1 Motel 0 Other <br />Number of living units. i Number of bedrooms a Garbage Grinder Lot Size /4 <br />i <br />Cloy <br />I <br />0 ,0.5 1 <br />Character of soil to a depth of 3 feet: Sand 0 i 'Silt 0 Clay 0 Plept .0 Sandy Loan' <br />Hardpan 0 i 1 Adobe 0 ,J11 Material if yes, type <br />(Plot plan, showing size of lot, location of sys'teirt in relcition.ko wells, buildings, eta. mast be Placed on reverse skle.) <br />I . i <br />permitted -if 'public sewer is available within 200 feet,) <br />Sizel: 1 1 Liqui!4 Depth <br />I <br />NEW INSTALLATION: (No septic tank or seepage pit t <br />PACKAGE TREATMENT [ 1 SEPTIC TANK I ] V <br />I <br />Capacity Ty Material No. Compartments <br />Distance to nearest: Well i I Foundation i 1Prop. Line ! ....r <br />I <br />LEACHING LINE ( ) No. of Lines Length of each line Total Length <br />'D' Box Type Filter 'Material . Depth Filter Material / <br />I <br />r , -- <br />Distance to nearest: Well Foundation 1 Property Line 11,4 <br />SEEPAGE PIT [ 1 Depth Diameter Number 1 Rock Filled Yes 0 <br />I I <br />:0- I <br />Prop. Line 1 <br />1 <br />.. • <br />.... <br />Water Table Depth Rock Size <br />1 t <br />Distance to nearest: Well k -• Foundation <br /> <br />REPAIR/ADDITION (Prey. Sanitation Permit # .1 .(--k Date .... ) r .., 4.--- 1 I <br />Septic Tank (Specify Requirernents) lid' ( n .rs'• , <br /> C) <br />6:4-c O.Liv6f: tV / /.4?",1>e-- W / la./Pe <br />i I P 1 <br />I <br />Loam 0 <br />(Ti <br />(Draw existing and ie4bire'd addition on reverse side) I <br />•••4- • <br />I hereby certify that I have prepared this application and that th-e work will be done In accordance with San Joaquin <br />County Ordinances, State La*, and Rules and Regukiiiirns of tlyS"-San Joaquin Local Health pl-shiet. Nome owner or licen- <br />sed agents signature certifies the following: <br />"I certify that in the performarice of the work for which this nonfat is issued, <br />ork on's Compensation laws of California." <br /> Owner <br />as to become sub) to <br />Signed <br />By <br />(If other than owner) <br />I <br />I shall not empl y any person In such manner