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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> -- -- ----------------------------------------------- <br /> (Complete in Triplicate) Permit No. _3_.`_ a-1.. } <br /> This Permit Expires 1 Year From Date Issued Date issued _-�J__-_I 3__:1 3 <br /> __-__________ <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. 549 and existing Rules and Regulations: j <br /> 4 <br /> JOB ADDRESS/LOCATIO .-----1,0.0-3_57 ----&-------FS-C,----BEY-QTT 19--------CENSUS TRACT --_�7-1--_---- M <br /> Owner's Name ------------- 19UA— pe" <br /> ----------------------------------- ------ -------------Phone w <br /> % <br /> Address ------1-3.0,3 ------c,�-------+ C------j3EL0 -A---- City --------JESCA— - - -- --------------------------•----•- <br /> Contractor's Name ---------10-WNE#�------------------------------------------------------License # --- Phone --------------------•-........ <br /> Installation will serve: Residence PI<partment House❑ Commercial :❑Trailer Court ;❑ ' <br /> Motel ❑Other ------- ------------------------ <br /> Number of living units_____________ Number of bedrooms ------------Garbage Grinder ------------ Lot Size -------------------------------------------- <br /> Water Supply: Public System-and name -------------------------------•----------------------------------------------------------------- - ________Private E]Character of soil to a depth o#-3.feet: Sa.nd'❑ Silt❑ Clay E] Peat E] Sandy Loam Clay Loam ❑ <br /> - . <br /> Hardpan ❑ Adobe '❑ FiFillMaterial _ _ _©__ If yes,type ---------------------------- <br /> {Plot plan, showing size of lot, location!6f system in relation to wells, buildings, etc. must be placed on reverse side.} <br /> NEW INSTALLATION: (No septic tank or'seepage pit pe fitted if public sewer is available ithin 200 feet,i <br /> PACKAGE TREATMENT [ ] SEPTIC TANK;[ I Size------------------------------------------------ iquid Depth ------------------__.,..._- <br /> Capacity -----------------•-- Type --------- --------- Material---------------------- No. ompartments ------ -----W <br /> .i <br /> A j <br /> Distance to nearest: Well ---------- ------------------------Foundation ------------- -------- Prop. Line ---- ----------------- 0 <br /> LEACHING LINE [ ] Nd �of Lines --_-- -------- - Leng h of each linebe -- Filter Mater tal. Lenge �-__-_________________111 <br /> 'D' Box -- ---- --- Type Filter Mater al ----- p , i I V• <br /> a .x. 1 <br /> Distance to nearest: Well ____________ __________ Foundation ------------------------ Property Line --------- -----------LA <br /> SEEPAGE PIT [ ] Depth' Diameter ___ _--__-__--_ Number --------------------------- Rock Filled Yes C] No i❑ <br /> WaterITable�Depth -------------------- <br /> ------------------------Rock Size --------------V <br /> --=------•--- rn <br /> Distance'to-nearest; Well ------------- _________________________Foundation __-____ _____ Prop. Line __-_____--____________fin <br /> !xi <br /> REPAIR/ADDITION(Prev. Sanitation Perm t%# _________ __________________________________ Date --------------------------- ------ <br /> Septic Tank (Specify Requirements) . ---------------*49P, �-------- .��r1��.!\I------ ---- 0 <br /> Disposal Field {Specify Requirements) ► <br />