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IM <br /> f / art . - <br /> - - FOR OFFICE USE; —J ('nyjdel «aiii- �..�. <br /> ............... ......... ..... <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit <br /> .... This Permit Expires I Year From Datt issued Date Issued ./ / "L <br /> Application is hereby made to the Sat Joaquin Local Health District for a permit to construct and install the work ha In <br /> deuriil .. Js,10 . liwtiw is/mladrs!n HancPwith(/taunty Ckdi x/U . 549 and istinp Rules and Regvlattons, <br /> JOB idLOCAIION E/? Y ��.Aock(492 CENSUS TRACT ...... .......... <br /> p -' <br /> Owner's Name �........Y.i..Tr <br /> r— <br /> Address .................... N. .q, .........:.Ory� ...G�i :....._.. ... . ......-.........._......... <br /> _�;. <br /> Contractor's Name ...] ... IS'-E.ec�fL.K:..�m.6f,S.....................Llcenee ti ......... .............. Phone .:56 X 61 ( <br /> Installation will serve, ResidenceP(Apartment House Commerclai[Trailer Court Q <br /> , <br /> Motel Q Other .......... - -. .. <br /> Number of hying units:.... ...... Number of bedrooms... ...... Garbo a Grinde,• .... Lot Size ...A.A...Gr .. .... 'i <br /> Water Suppiy: Prblic System and name ........................................................_......_....................................I....Private[ _ <br /> ihara:ter'of soil to a depth of 3 feet, 5cnd Q SJt❑ �:Clay.Q 'Paat❑ Sandy Loam Clay Loam❑ <br /> Hardpan Q Adobe Q RII Material..:. .._...:f yes,:type... .. .................. <br /> (Plot plan, shrwlig siza,of lot, locaticn of system: In relation to wells, buildings, ate most be placed.on reverse ak1o.) <br /> NEW INSTALLATION: {Na septic tank or seepage pit permitted !f p,itllic sRwer,is available within 2X feet„ <br /> nn �. <br /> PAOC;,r,E TREATMENT ( j SEnICTANK6C A Size- ... ..... ......... Ocivld Death <br /> Copacity.K Z 6 .,/". YPe...•r-/.�. �.r -al..t.2ic,.R.�i... No.r Cwnpartments . rte'._ <br /> T 4�4�-f' Moferi <br /> Distance to neasesn Well �... .. -Foundation . ......_. Prop. line- _./�`�_..._. • <br /> ^- LEACHING LINE No. of Lines '...:. Lengthf aach��line �Q..e Total wn- h <br /> 'D' Bbx ...{. Type Filter Moteric4t;l.- Depth Filter Matwfat _ l rr <br /> ' F_o�s4rrll++ <br /> D'aance to neamsh Well fl:'..: ..._.. dation. ...�..Q..-... .... Property Line ��....—... �; <br /> SEEPAGE PIT [ ) Depth ................... Diameter ................ Number ......_............:....... Rode Filled Yes Q No 0.1 <br /> Water Table Depth ............... .........................._....Rock Size .... ....... <br /> Distanca to nearest:Well ........................................Foundation .................... Prop. Line .........a..._._, <br /> REPAIR/ADDITION(Prer. Sanitallon Permit$ ......................................--... Date ............. .................. <br /> Septic Tank fSpecify Requirements) -' <br /> Disposal Fietd (Specify Requirements) ........ <br /> .............................................................:........._................_.._............,.......: <br /> ' ................................................................................................................................................................................_............... <br /> ..... .. . ... . . . . .... . ..:... ... ..... ............................................_..................................................................... _.......• <br /> ;• (Draw existing and required addition on reverse side) <br /> I Is mby_certify that i have prepared this opplica•lon and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Lawn, and RultJ and Regulations of the San Joaquin Local Health District. Hence owner ce Ittet► <br /> 14 sod agents signaevra certifies the following: . <br /> 111 corky that In JM performance of the work for whlch this permit Is Issued, 1 *hail not employ any person in such munner <br /> .. <br /> os to become wbje Wark�rta 's Comp cation law IF Gallia.-da:' <br /> . \_. Si, ned .... :�!-%�....�.f,.�'a..e,l.Owner _ <br /> By.......... ... ... ... ..:+4D1�N1 ..:..._.................. .. Title ... � l� «-Z/... ........ ..........:.. <br /> Of othv than owner) <br /> FOR DEPARTMENT USE ORLY <br /> APPLICATION ACCEPTED BY...,/'r.��2.r�P!?e..-....................................................... DATE. .... <br /> EUILDING PuMIT ISS.......... ED................._.... ...:............::.........._. ...,............. <br /> ......................................................... <br /> ..... <br /> ........ <br /> ........... <br /> . <br /> ADDITIONAL COMMENTS ......f:.t�!......Gf/rc ..f r, t�.Gh-:...... ......:.:.........:..DATE......._.....:..... .........:....... <br /> ...... . .............:..... <br /> .............. <br /> ...................................... ...... ��... ��1r� ....... .. .'. <br /> Final (mpsdlon by, .......... � .. ..... ........................................... � .....Date ...... . . . ........ I <br /> SAM JOAQUIN LOCAL HEALTH DISTRICT <br /> \fd'�(+� <br /> _.. <br /> 13 241.68 Rs_ -,�.... 7/)!31t s <br /> �Y <br /> rn"rft��,�. :: ♦�n ^ ? ... . � .. n . . s:"1 n�a.i:.w14.SeSZC,L�i°�l .�s' i6�.31i� <br />