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FOR OFFICE USE: APPLICATION FOR $AW rATIO N PERMIT <br /> Permit No. <br /> 70 <br /> ............. ...... .. omp ..... <br /> t. <br /> .. ............. ................................... Date Issued ....... <br /> This Permit E*pires I Year From Date Issued <br /> ---- .......----•----- ......,1.............. <br /> the work herein <br /> Local Hebith District for a permit to construct and install <br /> Application is hereby made to the San Joaquin oca'. iong- <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Redulati <br /> CENSUS TRACT ----------- -------------- <br /> JOB ADDPZISS/LOCATION ...... <br /> -----------Phone ------------------------------------ <br /> Q#vVi1ri' Name -------------7F <br /> ............................ <br /> ---------------City ................................... <br /> rPS .............•---•-----------•- ------ ­----------------------------- . . . <br /> . * cerise # �----------------------- Phone --- --------_--- ----------- <br /> Cciitrqctor s4bme ----- _----------jl� ................... ......................Li <br /> Installation will Arve: Residence �partment Houseo Commercial F]Traller Court 0 <br /> Motel C]Other ----_----------- . .............. <br /> Arinder ._-------- Lot Size ------------- ---- ------------------------- <br /> its- Garbcg <br /> Number of living un ............ Number of bedrooms .......... <br /> ----------Private M <br /> Water Supply:-Public System and name ---_---_------Si F❑ <br /> -it.- -------------­-----------...........................am [D Clay Loom ❑0 <br /> Character of soil to a depth of 3 feet- Sand F-1 Clay Peat El Sandy Lo <br /> Hardpan.[:] Adobe❑ Fill Material ----------- If Yes,1YPe.-_.--------••.;........... <br /> {Plot plan, .showing size of lot, location of system In relation to wellsObvildings, etc4noust be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tankor seepage.;pit permitted if.pubfic.Tse.wer is available within 200 Feet) <br /> i. Size..____ ------ %- - - ----------------- Liquid Depth -------------------------- <br /> PACKAGETREATMENT SEPTIC TANK-T I --- -­-------- <br /> Capacity .................... Type .........t......... Mat&�l------_----- No. Compartments --_----------------- <br /> Distance to nearest: Well ---------------------------------------Foundation ---------------------- Prop. Line...................... <br /> V, <br /> LEACHING LINE No. of Lines ------------------------ Length of each line............................ Total Length .-_----------------------- <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material ---------------------------------------------- <br /> Properly -----_----------------- <br /> Distance to nearest: Well ------------------------ Foundation, _.-.-..-_••---------_- oy Line <br /> C3 <br /> SEEPAGE PIT Depth _................... Diameter ................ Number _:---------------------•._ <br /> Rock Filled Yes [D No <br /> WaterTable Depth ............................................ ---Rock Size -------------------------------- <br /> I ...................... <br /> Distance to nearest.. Well ....................••---------•--......Foundation ......... .......... Prop. Line <br /> ..... Date-: ....... ­-- <br /> REPAIR/AB . <br /> .................. ......... .......................... <br /> Septic Tqnk,(Specify Requirements) ... .........M. . <br /> Disposal Field (Specify Requirements) .-•-.-----•-- ---•---....-----•--••--- •'.. ----------------------------------------------------------- <br /> 7. . ......................................... ...... ............................................. <br /> ------------I.................. .............................. -------------- ...................... . <br /> .................................. ..................................... ....... .......... ....... <br /> .:................................•-. . ...............­­............................. 4 <br /> (Draw existing and required addition on reverse side) with San Joaquin <br /> I hereby certify that I have prepared this application*and that the work will be done in accordance <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local-Health District. Home owner or licen- <br /> sed signature certifies the Following: <br /> "I certify that in the performance of the work for which this permit Is issued, I shall not employ any person In such manner <br /> as,to become to Workman's Compensailin laws of California." <br /> I , ------ <br /> Signed ------t----------- ------------------------------------••------•-------------- <br /> - Owner <br /> ... Title -----_---- ----------............. ................ <br /> By f1l,� 4. <br /> ................................................ <br /> p/ :t �anoN�;ner) <br /> FOR DEPA;RTMENT USE PNLY <br /> .':.APPLICATIV4 ACCEPTED BY ...... -_-_---- ---------------------------------------- --- -- ­ -------------------------- DATE --------------- <br /> ........... --------------- ---- -- - <br /> LtUILDING PERMIT ISSUED ................................... DATE..................--....--....------------------ <br /> ..i--------------- <br /> 7ADDITIONAL-COMMENTS ....................................................................... .......................... .................... b <br /> ................................... ................. .... <br /> 110*................. ...........................................--------i........................................................­ ........... <br /> ------------------------ -------------------*---------------------------------------------------------- ---------:-- ----- ---------------------- ------ <br /> . . - :---- ------ --------- <br /> ....................­-_­­................. ..........................--------=----------••---.. -Date <br /> ----------- <br /> inal Inspection by: ..................I............... --------------­------- <br /> .,' SAN JOAQUIN 'LOCAL 14EALTHdTRII� <br /> E 1. 9 1-'68 Rev. 5M <br />