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<br /> ' -FOR OFFICE USE:. FOR OFFICE USE
<br /> APPLIC TSQN FesAN! ATION PERMIT
<br /> .......:: .............
<br /> Permit No 7
<br /> (Comple l_ In Triplicate)
<br /> .......... Date issued
<br /> ......... . ...... . ............................. This Permit Expires t Year From Date Issued ,
<br /> �3 6yJ
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<br /> . Application is hereby mado to the San Joaquin Local Health Districtfor a permit to construct and install the work herein described. ,
<br /> < This application is made in comLilionce with County Ordinance'No.549 and existing Rules.and Rer•rlations:
<br /> „ Mr
<br /> r _JOB ADDRESS/LOCATION'
<br /> _r��1 C� gA T� /lJ.. C/ CENSUS TRACT
<br /> Owner's Name •~ _ ... - ... ..- -- $.7
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<br /> s �.Acldress... L�L�I ti Cl` IP
<br /> . .+ . .I.�JG'.: -...C�,�.4 .N. . : ty.. .any
<br /> .::.: ...... Phone...
<br /> contractor s Name Wa /._:........ ..... ........... License # Phone �k L
<br /> _ t;installtn velli ❑ Apartment House(] ' Commercial❑ Troller Court.0
<br /> aioserve. a Residence M -1
<br /> Motel (] , Other-- ..... s� r
<br /> ;Numbsar,cf livin �umts.....:'-..Number of bedrooms.:. .Crarbage Grinder ...-.LoP-Size
<br /> t#v g
<br /> , r a .. .: a.Privatel
<br /> Water SuPPIY ,Public System and name:. .. --.... ............... yy-
<br /> s } �F1'131
<br /> Choracter of soli to a depth of 3 feet sand❑ :�Silt❑ .Clays❑k ?eat.❑ Sandy Loam E]`` Clay Loam ❑ �s, l 4 n ?fes f
<br /> Hardpan.❑ AdabeFillMatenal = if es, e.. aFs{ ` u
<br /> y = ;
<br /> 'A—(Plot plan,'showing s ie of lot,-,location of.systern in relation to wells buildings,"etc must.be�laced on reverse ilde.]
<br /> � h i NEVI-INSTALLATION—-(N o septic tank,or seepage pit Perm, a ff public sewer fs ava�lalile withln}2p0,feet[ Fi
<br /> Y ,1 f�
<br /> PACKAGE TREATMENT (i]
<br /> SEPTIC
<br /> ti '�+51xe( Liquid�Depth � f� fin,
<br /> t4"f '+ r-'` f Ca act tP T e ' tiv5ateria)_ Nal Comportments' s
<br /> e' s Y rA < ver �r+kK 5 '.p y' ; YP �r
<br /> s ev •,',} ff" y s,C Distance--to nearBSt Well .. Foundation 4 Prop�4Li e�'1±?=�' �i ;�� +'Cy X
<br /> LEA;CHING LIN 'Frye`] ,ak..ft �i th- ofI eachNn.or Lnes Len Iin+j a ` $- = ajt' -�Tottal"Length-r # #}`I'��41„°� F��•3,"l N"���14ra(� a,s+rFa'
<br /> ..
<br /> Type Filter Mater}aI° ` Depth F11ter Material "q
<br /> ah ¢TIxr#'tq '!+'
<br /> _ r r1 .tr * `Property Line .
<br /> vrar r, r s II `" �Distanre to nearest W II ' .Foundation
<br /> r;'; .. f �,�.Y.ys�e -!�;ars -.i,.y-z k �I i •_r rg y 1-j
<br /> �,�.SEEPAGE PIT Diameter Number t Itock�F�lledYe ❑ No
<br /> 'Water-To
<br /> Rock Size a `as �rS�r;4yf
<br /> , _ r `� - ." ' r - .• r ref°+o }�
<br /> r � Diatanc to nearest Well
<br /> nda f
<br /> Fou tion Prop Line
<br /> s t x at4
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<br /> REPAIR/At1D1TION [Prev Sanitat�on Permit#.... D i�
<br /> , Septic Tank>{Specify Requirement]. ter`' ---- �'- r-d LP
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<br /> Fieid„(Specify Requirements) ............ . . /+
<br /> 7E V'rF�Fr' jfRL1+F '
<br /> ................................................................- Y�t'y�y..
<br /> �5
<br /> t .� '64A
<br /> �A
<br /> [Draw existing and required addition an reverse side]
<br /> ' z I.hereby certify that I ha4 a prepared this application and.lhat the:.work.veil!_be;,done m accarddt+ce with San-Joaquin C
<br /> }^� i
<br /> t ?Oidinances, Stnte. Laws;: and Rules and. Regulations of;the San Joaquin Loco l'Health District' Home owner or
<br /> agehis�A
<br /> signatz We iilfi” the following c'; .
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<br /> "I,iertify thai.iri'the perfarrrianee of.the"work for.wh h `his per`mihis issued;1sha!! not employ' ;ny person In srsh m+snnerlasstiN '
<br /> to:become.sub' t 7of,Ylrp man's p ation`•1 of`California." tr^4
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<br /> t t o n' y�+�
<br /> 4A Signed': WrcS�=
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<br /> •:.,. ,. -rr t ,.: .:
<br /> -------- ...---a ' a•..... ..i- ------ -9.:x•5 l�i�
<br /> - r Title '
<br /> -other than owner] '
<br /> 4. +- r s'' a + FOR DEPART NT USE ONLY"
<br /> ra G-. ! ,1 3pr a
<br /> AP,kICATIO,�f'ACCEPTED. BY,. ... .........
<br /> r DIVISION CF LAND NUMBER ....:.. -.... :.. -••..... --
<br /> •..t DDIT16NAL'.COMMENTS. - .....:. ...............
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<br /> Final Inspection- Date- ce sien.aev:Ana sM
<br /> SAN
<br /> i3 s� JOAGUIN LOCAL HEALTH DISTRICT
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