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_ S " a= <br /> �- APPLICATION FOR SANITATION PFRMiT <br /> (Ca.nalata in Triplicate) <br /> Permit Nc_20.r.0.R...... <br /> _Y This PrA_t Expires I Yew Dale Issued Date Issued g_M_;3...... <br /> Application.i; hereby made to the San Joaquin Lova}Health District for a permit 'o construct and Install this yolk herein <br /> loseribed.This application is made in compliance whit County or+dininee <br /> We. $49 and existing Rules and Regulations, ' <br /> 108 ADDRESS/LOCATION .....5he11 St:;t:faa - 3fore2aad & Haaaeert 5tocktore CENSUS TRACT ....................... <br /> Owricr's hiarnrt .....Filmer,Cortst..........»................................................. .... <br /> 6fJ4f1Sa .................I........».._.._ ...................Phone... .............__.... .... <br /> Address ..... ?..•Fuaa................................................................ _Cty... ic. ..E�eiB}?te.,...� <br /> Controttor'sNome CPrtifA d Sever Inc. ... pf+ 749�_�,•__ <br /> Been .25417 one <br /> Installation will serve, Residence Q Apartment House 0 Commercial QTrailer Cou,r fl <br /> : F Motel in Other......St:7c dcn...ataltjax►..... <br /> Number of living uniFsr.......... :number of bedrooms ......._Garbage Grinder............ lot Siza ...»»...».„..»...... ,,,..,. � <br /> Wome Suppfyc Public System and mane Q .,.._ <br /> # C` -+actor of soil io a depth of S fes±: ,Sund Ll Silt 0 Clay p Pear Q Sandy laanr Q Clay Loom rj <br /> l Hardpan a Adobe❑ Fill Mnierlal............IF yes,type... .... .. ........„ <br /> a [plot plan, showing sizr, of lot, location of system In relation io wells;buildings, etr, must be placed on reverse side.) <br /> NEW INSTALLATION. (No septic tank or seepage p;t permitted.if public sewer Is available wlthin 200 Fest,) <br /> r _ t <br /> PAC-K--A-G--E--TREATMENT )) SEPTIC TANK ', <br /> ...»._ .».............. <br /> ..» ... Liquid Depth <br /> Capo fY..............» ipp . . _ lRateriii» . ........... ...._..................... <br /> NO. Coin t eenta ». <br /> i Dist,:ce to nearest, Wail .. .. „.. �. .�..,FaundaHonProp.Line, <br /> t LEACHING LINE �) No. of Lines Length of each lima.. <br /> ' Tmj Length <br /> T,' Box....... Type Filter Material .................,,,Depth FEltwr Muterl�% <br /> Dinarce to na"ste Well» <br /> ,'"`� • , tlt7n .::.. .... .'�Prapsrty tSrea ...,:..�._.:, <br /> [1 P .. .. .» Number Rode flgod Yes No�] <br /> DEPAGE PIT Ot th .......it.-- Diameter 3 <br /> e s Water Table Depth .. ..._.. .....�..,.._�_ Racl:Size.»�.,. .....». :.».. <br /> Distance to n6orosh Well E` , »..r »... P:re`, line A_ d <br /> (Pey.SanittlnREPA14JADDITION hermit# <br /> Dale . <br /> hSeptic Tank(Specify Requirements) ..........»...........w...»... . ........ .. ......... . .» ... .......) <br /> G Disposal Field (Specify Requirements) ..... <br /> ..�..,,. ..� .,... . _ <br /> ...... ......................................_ ............ .............. .» . »....._...... __:._._ <br /> sZt <br /> [Draw existing and required addition <br /> y I hereby certify that 1 have prepared this applico3on dnO That the work will be dent In accordant* with San Joaquin <br /> : Coentp Ordinances, State laws, and Rules ord Raguladons of the San Joaquin easrcome e <br /> uin Local Health District.He<rnw®r+can- <br /> � f i <br /> sed agints slgnat•1ze cartlfies the foilowinat <br /> t "I certify that Ir,tht lresformance of the work for which this erect is issued, 1 shall not employ' d• p y arty person In such manna! { <br /> 9 as to becomr sVb et to W!Tkan's Crptnsafl,,n lows of Coilfr—do" <br /> r Sinned 1 P''!. �Ll.4'.�.:... .` Owner <br /> PBy l.............. . ......._...._.xitle....... .......................__..... <br /> [ (!f other thou awnerf . .. <br /> DEPARTMENT USE ONLY <br /> PLICATIONACCEPTED-BY " <br /> x : <br /> DATE PERMIT ISSUED . .. ............................. _...:LATE ... ...........ADDITIONAL COMMENTS ; <br /> Pmol IRspettian b%i Z� : l ..ts, ` .... ..._ <br /> & I_ <br /> 5ANJOAOUIN LOCAL HEALTH DISTRICT <br /> MINE <br /> f <br />