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ASR OFI4CE USE: <br /> APf`,/ATION FOR SANITATION PERMIT 'est ,/ <br /> (Complete in Triplicate) Permit No. ,7. - <br /> - ---- -- - -- This Permit Expires 1 Year From Date Issued Date Issued ,r: ....Z <br /> application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> le ribed. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 'C5g ADDRESS/LOC/XIO� Np ,R .It n �p� E/ � ( �C'G'� ; <br /> h ier's Name t k P-s M CE ACT . . <br /> CENSUS TR <br /> kc.jess ,/ - .Phone <br /> r , <br /> .ontractor's Name ti.,,-._c.,>.• ... - """"'.'."'.... <br /> 0 Wit• P!G`. Aicense # Phone - . <br /> is illation will serve: Residence jT Apartment House[] Commercial ❑Trailer Court <br /> Motel p Other <br /> lu -ber of living units: Number of bedrooms �^hi........Garbage Grinder Lot Size .- <br /> �. <br /> Vc_.�r Supply: Public System and name <br /> ...... ...........Private Q' <br /> haracter of soil to a depth of 3 feet: Sand 0 Silt❑ Clay Peat❑ Sandy Loam ❑ Clay Loam ❑ f .. <br /> Hardpan (] Adobe ❑ Fill Material If yes, type . <br />'lot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> IE INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> ACTCAGE TREATMENT [ ] SEPTIC TANK Liquid Depth Capacity ..!� - <br /> Ca ba o .... <br /> P Y Type .9'��� Material.(t-V�--�... No. Compartments 22 ................. <br /> � Distance to nearest: Well � Q � ....Foundation . � O ... Prop. Line ...�..._.__... <br />:ACHING LINE V/ No. of Lines 3 Length of each line Total Length � l. .�... ..... <br /> 'D' Box Type Filter Material ._.0-f .....Depth Filter Material - /�7 '• <br /> ........ ...................... <br /> Distance to nearest: Well . /100., ___ Foundation /0..oe Property Line S <br /> ... ............ <br />_EDAGE PIT [ Depth X25 Diameter �� ........ Number Rock Filled Yes No ❑ <br /> _ Water Table Depth t?„ �._,_. ......................Rock Size 7......... <br /> Distance to nearest: Well ..�. .Sr_t_�...............Foundation �[j r .... Prop. Line _.S ....... <br /> cP IR/ADDITION(Prev. Sanitation Permit# ...__. Date ..... . _.......___.) <br /> S1115tic Tank (Specify Requirements) - <br /> D;•posol Field (Specify Requirements) .__ _. . . _._. <br /> (Draw existing and required addition on reverse side) <br /> heby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> wnty Ordinances, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> d -gents signature certifies the following: <br /> c, rify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such mormw <br /> to become subject to rk en's Compensation laws of California." <br /> In^H ... .. _. . .. ..... Owner <br /> Baru �/� •_ Z"`TSP? I,_ . Jitle �(/I Gre�t� w✓ <br /> (If other t an owner) <br /> FOR DEPARTMENT USE ONLY <br />'P.f.ATION ACCEPTED BY _ /0 -Z _ <br /> hLDING PERMIT ISSUED DATE.DATE �y <br />>DiiIONAI COMMENTS / 17 ys �Ou� <br /> f y <br /> ia! inspection by: .._.. .-. . .•_ .. _. _. _ _._Date ..� `� ..-. <br /> LSAN JOAQUIN LOCAL HEALTH DISTRICT <br /> H.13 24 t•'RA Rov SM �r�v <br />