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POR OFFICE 11SI's: <br /> APPLICATION FOR. SANITATION PERMIT <br /> , er..- ti . _ tConiplete In Triplicate) Permit No.,; B'-J�•�Q = <br /> ...::.....:........:.::.................... Date Issued Ja._,,V_.2£f <br />......................................................... This Permit Expires 1 Year from Date Issued <br /> Application is hereby made to the San Joaquin Local Wealth District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> a ��3 3 r �oNs �'scr� Low CAS <br /> JOBADDRESS/LOCATION ..._ .........r......,_,_-....,...-•-•----••---------••---....�.._..._.... ... ..............CENSUS TRACT _-----------_----------_ <br /> Owner's Name Xe-&A.4..---•-•lir± 'i.,f ------_------•.. ...........•.:.: ...................Phone ----------- <br /> Address ------�/�!�'-`............................•----•--•---._......:._....-----...:...._...__.........City ......... - <br /> Contractor's Name --------9120-- .._...L€caense . Phone . <br /> Installation will serve: Residence ER Apartment House 0 Commercial OTrailer Court 0 a <br /> f.� Motel ❑Other........... :............................... � <br /> Number of living units:------- Number of (bedrooms � Gauge Grinder Lot Size <br /> Water Supply: Public System and name......................................................... ....----------------------------------------------Private ❑. <br /> Character of soil to a depth of 3 feet: Sand❑ Sift❑ Clay ❑ Peat Q Sandy Loom Q1 Clay loam <br /> s <br /> Hardpan Q Adobe❑ Fill Material ............if yes,type ............... ......... <br /> (Plot plan, showing size of tot, location of system in relation 'to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No`septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT f a SEPTIC TANK" Size................................................ Liquid Depth ........................ <br /> Capacity .. ,C1.a/Ir4-.4ype A Material.............:. ..C—No. Compartments �..:.�..... � { <br /> Distance to nearest: Well ..._./P.._ _ ................Foundation 0__/-..._.. Prop, Line ....9:............. <br /> LEACHING LINE (� No. of Lines ..9................. Length of each line....����...._.... Total Length/ ' ...... ----•-....... \� k <br /> � ... <br /> D' Box ..G Type Filter Materia �� ;`Z2 �l Depth F€Iter Material ...A?................................ <br /> . <br /> Distance to nearest: Well -f`J�------- -• Foundation ..-,---� •�:_-.. Property Line ._ .•...._.... <br /> SEEPAGE PIT4Y [ 1 . -• Depth ......�............. Diameter ................. Number .............................. Rock Filled Yes ❑ No (3 <br /> # 'S ,Water Table Repth •.Rock Size <br /> .._. ...----•......................•- - <br /> i � , <br /> ' Di§tonic to 'iecrest: Well .f=oundation Prop. Line <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation Permit yQt • ............ Date .................................. <br /> SepticTank (Specify Requirements). . ....:........... ..............................:.........................•....... ..._..... . ... --------------......_---- <br /> Disposal Field (Specify Requirements) ......--••-•-••----- <br /> . ................................ . ..............................................................•__..__.__ F <br /> i t <br /> ................. <br /> --------------------r ._..._`------------------•----. - - s <br /> :.:............................._...............,.....-------••--•:---------'...__.._........_.....,_.___................_......_......._._......... _ <br /> : ..... .... <br /> 4(Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local: Health:District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "1 certify that In performance of the work for which this permit Is Issued, I shall not employ any person in such manner <br /> as to beco esu t to 3Nf rIc an's Compensation laws of California." <br /> ee <br /> !r� <br /> Signed .. ------ ... - ._.._..._ --JE+_`-/ __ owner <br /> CBy ------------------------------------------------------------=------------------------------------ ------ Title ----. ._----------- ....... <br /> i (If other than owner) <br /> FO EP'ARTMENT USE ONLY <br /> APPLICATION ACCEPTS© BY •• ------.. ................ •------ --------- - -_ _.----..._:__...DATt .... .: ....._.:.: <br /> I <br />€; ,BUILDING PERMIT ISSUED ------------- ----- DATE - <br /> •--- •------...- <br /> ADDiTiONALCOMMENTS --- ........................---------•-=........................................................................................... <br /> -----------..............--------------------------............ --------- ............................. ... <br /> ._.._. ....----•--------•- •--•--..............-----....._..........._.....--..-.-._. <br /> � A <br /> ........................••--------------------------._..._..--------•._._..__-_.._._...-----------•-------................,'------­-------------- -• <br />' `- - - ---------------...-- --•------ - - <br />� SAN JOAG?UIN LO AL ----_------Datefinal Inspection by.. <br /> EH 13 2I 1-6 # Rev. � HEALTH DISTRICT 874 3M <br />