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FOR i ..c: <br /> 1PPLICATION .FOR SANITATION PEr'"11T <br /> ......................................................... �77-_I 30P <br /> �.► (Complete in Triplicate) i Permit No. ..............._.... <br /> This Permit Expires i Year From Date Issued Date Issued ...'17a? 7/ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 9 and existing Rules and RegulaHonsr <br /> a 6 9 So 4 /usc' <br /> JOB ADDRESSA ONL......................................... r .... .. ............CENSUS TRACT ....... ................ <br /> Owner's Name s. '!-W-2d . .. . .K9/ h - ..... .. one Y--A?100-1......... <br /> Address . .... . .... .. _ Ci �It <br /> Contractor's Name .....fY.! .!x. .__.................................................License #E .... - ------- Phone .................. <br /> Installation will serve: Residence®Apartment House❑ Commercial QTrailer Court <br /> Motel ❑Other. .......................................... <br /> Number of living units:...:..... Number of bedrooms . . .....Garbage Grinder ...... .... Lot Size ....- _.�C' <br /> ........ <br /> .............•--...--.._� <br /> Water Supply: Public System and name ...... .........._..........................._._..__.........................._.__Private❑ <br /> Charader of soil to a depth of 3 fest: Sand]] Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe 10 Fill Material ............If yes,type ......................._.. <br /> (Plot plan, showing size of lot, 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 [ ] SEPTICTANKI ] Size................................................... Liquid Depth .......................... <br /> Capacity/�a�(��#.LL�� <br /> Type .............. . MateriaY2kt,}t i 'No. Compartments ... ... <br /> Distance to nearest: Well ...o00.......................Foundation .../0------------ Prop. Lina ..4 .... <br /> LEACHING LINE [ ] No. of Lines//.... __....----- Length ofeach <br /> �� line..........F11)... ....... Total Length .�.�........... <br /> 'D' Box ..._C..... Type Filter MaTeria�.C//// <br /> .�LE�� G: Depth Filter.MaTeriol .......,/ .....................�c..... <br /> Distance to nearest: Well . QQ.......... Foundation .Zd................ Property Line <br /> SEEPAGE PIT [ ] Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 <br /> Water Table Depth --....... .....................................Rock Size ................................ <br /> Distance to nearest: Well ----------------------I.................Foundation .................... Prop. Line ..................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Dote ......................._......... <br /> ) <br /> SepticTank (Specify Requirements) ................... ....................................................................................._..._..................._... <br /> DisposalField (Specify Requirements) ..................... ....................................._.._._......................---................_......._.._.......... <br /> _.. . .-..._._.. - _ -_._.... - -----------•............ .... .......................•-•--........-----...-•--•-•-••--•------------•------------ ---------..........--•-- <br /> ....- ...... _ -------------------__----- .... ... ......................----•............................... ....................................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 /> "I certify that in the performance of work for which this permit is issued, I shall not employ any person in such manner <br /> as to beco a ubj t�to,,W(,/�}1k�m'an's mens :on laws of California." <br /> Signe � rK1 .._... Owner <br /> ....................... . <br /> By ..... .............................. <br /> ­------------- <br /> . <br /> ._............._._..........----._.. ..._.._.. Title ._ ._....................... <br /> (If other than owner) <br /> FOVWPARfAdENT USE ONLY <br /> APPLICATION ACCEPTED BY).... ...................................................... DATE . �....._"7------- <br /> BUILDING PERMIT ISSUED . DATE . <br /> ADDITIONAL COMMENTS6a ----.... .------------- ----------------------- _ _..._ ... <br /> ,. ki.-.. reK .-._ .. :2.. ..ctG�, .t: � . ..-...���.................... <br /> tr:.:.e.._....... _..._........ .......... .................. . ........ .. .... ... ............--- . ......-.......... ............................ • - .. <br /> .. --.. ......... . ........_.. ..------ <br /> ..,... <br /> ._.. <br /> Final Inspection <br /> by: ..............".�.. . . at .... ...�............................ <br /> Elf 13 21a 1-61f lieu. 5} SAN JOAQUIN LOCAL HEALTH DISTRICT 874 3M <br />