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,rN1 <br /> `,F f <br /> FOR OrriC-` us[. APPLICATION FOR SANITAT1r N PERM - <br /> Permit No. .•.'.. ---..--.. <br /> fc3mplete in TH1,11cote) S )G i <br /> This Permit Expires 1 Yew From Date Isawd <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install tore wo",- heteMh <br /> described. This application is mode In compliance with Cour.:y Ordinance No. 549 and existing Rules and RoguleSO Mt <br /> JOB ADDRESS/LOCATION . 4732 Be.HIildi'ALh.•Lie.................StOCkWa........ ...... .....CENSUS TRACT .....__--••- - <br /> Owner's Name Chaz',L94.m ................. ..................................................Phare M!!101185.. .._......» <br /> AddressCi .............................. <br /> Contractor's Name . solz1..JAG,................License tli ........................ PhoM ..a <br /> Installation will serve: Resiclonce COLApadviwnt Hwse0 Commercial❑TrcllW Court ❑ 1 <br /> Motel0 Other.......................................... <br /> Number of li,*ing unit,: I. ..... Number of bedrooms .3.........Cctrbago Grinder ............ Lot Stu S�Q!...�51t...... .............. <br /> Water Supply: Public°,ystem and name ............................ <br /> .._...»....»...................._.»........._............._.._....flrlvde <br /> Character of sc't to a depth V 3 fr e, Sand 0 Silt 0 day ❑ Peat❑ Satnll►Loam❑ Cby Leh ML } <br /> Hordpon❑ Adobo-n Fill Materlal............"V",thf>>•�....- -. »»... <br /> (Piot plan, showing si,-e of lot, location of system M relation to wells, buildings, etc. must be pksoed on refit -A OW <br /> NM INSTALLATiONt (No septic tank or seepoge pit pwmWW H public nwa Is avaik"VA*Mt 200 feta <br /> PACKAGE TREATMENT ( ] SEPTIC TANK I Slee.......»»� � ?�......................... Liquid _.._.._............ tJ tt <br /> Co parity .15017.......... Typeft*!rA1%_... MgW101113 1M1�"lU..... No. Compattr»nN ..._..'> -- 1 <br /> . <br /> Distance to nearest. Well -5.01................._.......Foundation hop.Une _ ..... <br /> LEACHING LINE (31 No. r•f Lines ..I................... Length of each line......101..........I...... Told Lettglh -- <br /> 'D' 15,4L........... Type Filter Material S9plu..ftDepth filter Material ............ <br /> Distance to nears••• Well -.5W.......... Focxhdotion Wit- Preoperty 1M1r4!........- -----c �.1 <br /> SEEPAGE PiT Depth ..25.x........ Diameter .kAt....... Numbe, .......IL................. R.oc+c Filled Yee WL "D Q1 <br /> Water Tab!f, Depth .....QSt»..»..»»»...„......_.......Kaci Shoe . �............ <br /> 1 11 <br /> Distance to neomst, Well ...3M!............_......... ..»:...... Prop. L!t» .....�_.......�» <br /> REPAIR/ADDITION(Prwv. Sanitation Permit iw ........................................... Dote ............... <br /> Septic Tank (Specify Requireme4ntsl ..................................»..... ........................................_.»............._.-........... <br /> _....... <br /> Disposal Field (Specify Requlrements) .............................................................................».............. ...................................». <br /> _...._ _............... .... ...I .... ............ .............................»..........»............................»..... . .. ..........._..».. ..................• <br /> • »....................... ». ».. <br /> (Draw existing and required addition on reverse skle) »...�• <br /> I hereby certify that 1 have prepared 144 upplicatiew and tkat Ilse work will! be dews IN 66W*W” VA& Sin Jee>111ifs1 <br /> Cewhty Ordinances, State Laws, and R,•las and Regula'tlem of (lite Sew Joaq iw Leal MGM Dlslrid.Meme 0WVW or now <br /> sed opents signature certifies the Follewl39• <br /> "I certify that in the performance o' the rk for which this permit Is Issued, 1 s11tem wel Pa so any pots"IN okv'x:AemeB t <br /> os to become subject to Work rear's Compensation laws of California." <br /> Signed .._ It« Pasrr3e}t & 5K?1�'e.,, ................. .�►itr <br /> . . - Title . .jbtimtor.... ..... <br /> . ....... ....... .. <br /> (I: other than ownerl `'- —- -- <br /> FO DEPARTMENT US! ONLY <br /> APPLICATION ACCEPTED BY -r�.`.. .............................. DATE ... <br /> .S .� <br /> ;��/ <br /> BUILDING PERMIT ILSUED ......_ .... DATE . ..._........................»...... <br /> ADDITIONAL COMMENTS ........................ .r,..............................»._._........ ....................................... .. ..............:...... .... ::..f _ <br /> '*"**" ' ' <br /> -7 <br /> ..... ...... <br /> _. .... ................. ........... ....... �.... .. . <br /> ..... <br /> i b e ... ..................pate .. ...... .. 1 . 111 <br /> Final Ins er on 1 <br /> a p r 8/7b 3!l <br /> ' EM 13 21, 1-68 Rev. 5M c AN JOA N OCAL A H DISTRICT <br /> #�0R <br />