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.................:...... .............................. Date Hswd..V.01-V <br /> ..............................._..............._. This Permit Rrplres I Year Prem Dish Issued <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h6rein described. <br /> This application Is made in compliance with County Ordinance No. 549 and existing Ruies and Requlationsi <br /> JON ADDRESS/LOCATION ..._�j/,3co.... , „.....................CENSUS TRACT............... .... <br /> Owner'. Nam. . .... ... . . ....... .. .Phone y..7,�- Sl , <br /> ................ <br /> Address.......... .... ...��b...././.a. �Ktil../I . Ct .,........21p...............`.....7 <br /> / ,y. <br /> Camaoor's Name... .......Llanw/i..r�.�?�i�.. .Phone.�J��> ... ......._ <br /> ..................... . <br /> Installation will ave: Residence C Apartment House C Commercial jW,�jrailer Court C <br /> Motel C Other..........................................T <br /> Number of living units. ............ Number of bedrooms...........Garbage Grinder... .......Lot ................... .. 4 <br /> Water Supply. Public System and name_ ..............................................................._......................... ......., .......................Privcft <br /> Choracter of ail too depth of 7 feet, SandC3 Silt C ClayE3 PearC3 Sondy loom C Cloy Loam C <br /> Hardpan C Adobe Fill Material ... ....It yes,type.......................... <br /> - - 1 <br /> IPW 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,) r <br /> PACKAGE TREATMENT ( I SEPTIC TANK IM' Size <br /> ._'3AsC .................................. .Liquid Depth...y................. <br /> Capacity. g .....TypeD.t. pT..Mobriol ... ....No. <br /> Compartments......... <br /> .......►........ <br /> Distance to nearest, Well.... .Q�. ... ....... ..... . Prop. Line....w`'1... .... <br /> LEACHING LINE ...... 'y . .. .. . ... .. r <br /> I'1" No. of Units . .. .Length of each hese..... D.. . . . Total Length . ..S..rO.......................... <br /> 'D' Box . . .. . Type Filter Material..4-App Depth Fillet Material.. .... Ke................................ <br /> l 7 r � <br /> Distanutonearest,Well... Q.Q......�......Foundation..../A.................Property Line.,�...s ............ <br /> SEEPAGE PIT lbf' Depth-AS' . Dlometer-3.3.... .....Number.....1....................... q 0r Rock Filled Yes® No <br /> Water Table Depth........t0'G.......................................Rode Slee...abei................................. <br /> Distance to nearest. Well.../. SD.....f..................Foundation...... ......Prop. Une..�.�. ...... <br /> REPAIR/ADDITION (Prev. Sanitation Permit IF......................... ._...................State........._.................... .............. <br /> � <br /> Septic Tank (Specify Requirementsl._. .. . ......................................................_...............................,.. . ............................ ....... <br /> DisposalField ISpedfy 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 Son Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> 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 as <br /> to becomo subiecto man'/yy( en <br /> //�^���`pymp� cnon laws of California." <br /> Signed . . .. - `r-% T - ... _. .Ower /1 <br /> By ._.. _. ...__._.. Q,P-1 t./ .-1� Titlen... . _ �........... _. <br /> (if other than owner) <br /> FOP DEPAPX NT Ulf ONLY <br /> APPLICATION ACCEPTED BY........ . . .. .. ._ . .... ....... .. ........................ DATE g _.. .._ ..... . <br /> DIVISIONOF LAND NUMBER __.......... ... ....... ........... ... .._.._.... .. .................................. DATE _. .. __ _._... . ............... <br /> ADDITIONALC..r.1MENTS ..........._ .. ..... .. .................._........................................................................................ ... .......... .. _ .... <br /> . ............... .. .........._............................................................................................................ ......I.. ........ <br /> ... ..... _........... ..._ _.... .....__.......................................................... <br /> ......... <br /> ......................._................ <br /> ...... <br /> . .... <br /> .... <br /> ... .... <br /> ... <br /> -.... <br /> C,.. ' .. ..... .. ......... <br /> Final Inspea&an t7y:. ..... ..(' .... ..� .cy,..,-.. K.... ... .`.. .... ......e.. ._.......... ..... <br /> rr 13 24 SAN JOAQUIN LOCAL HEALTH DOT nr.A� t^ r'-':z..�.?-V:-�!.t's 2107 ssv.71163M <br />