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FOR OFFICE USE: r"# $97�'`* <br /> APPLIt:d,71ON FOR SANITATION PERMIT <br /> (complete in Tripiie. l PJeC4 ? <br /> ........................ .. d <br /> O <br /> i <br /> ' This Pennit Expires i Year gate Date Issued Date Issued <br /> ... .......•.......__- <br /> r Application IS hereby made to the San Jooquin Local Health District for a permit to construct and Install tho'work henlis <br /> described This application is made In compliance with County Ordinance No. $49 and existing Rules and Repulationst.;I", <br /> fJ08 ADDRESS/LOCATlON ! .... n.• ! f�7 + <br /> f .. 1.. ........................................CENSUS TRACT <br /> ti+ Y, Owners Name :: �^'t' E•••-....._ .._.. ............. ....... Phone . ' ... `Via... <br /> ... . .... •--•••-------•---- - .City.. � <br /> xCantractor's Nanie�. .: .................................. ..........................License# ... ..... ... Phone <br /> a <br /> `;�instaftilori will Terve: NRes[dance p Apartme• House[) mmercia!)]Trailer Court 0 <br /> i rwr; -71k . !�s�y'� Motelj Otha .. ,.(�. ( ......... ... .. ; v <br /> _of. <br /> of hying;unitse...°.. ::: Xumber of bedrooms .... <br /> ........ Grinder ............ lot Slzs_:.. <br /> i,.J , t <br /> aWater'S6pplyr Public System and name ......................»�..---_..... FPri <br /> TCharacteraf soil to a d0., of 3 feet' Sand[J Silt© Clay © Peat❑ Sandy Loam Q day Loam <br /> Hardpan❑ Adobe❑ Fill Material...........If type <br /> 1Plotyplan,[shawlnq size of lol, location of system Inrrelation,to wells, buildings, etc roust be;placecl'on rsrverse sid�.J <br /> , <br /> W iNSTALLATiGNc� `(N o[Sep tec:tank or seepage pit permitted if public sewer is available within 200 fest,)„ <br /> 'PAGKAGE4 TREATMENT k[] SEPTIC TANK}tJ Size...flD+ '� . P <br /> q �-� <br /> _ Fti,,4RizNX- <br /> pe+wapacity $ � . Type Gr!! Material �Fri­ No y , : Well �i0�.. .Foundation 3A' .Pr pLiP� F�.a 'vy L.- [ '7�"'I•�Y '.. ^... � ... <br /> LEACHING"LlNE �j tVo` of l nes )f <br /> ................... length of each line.' p ... Total LengtFt '�lt�l <br /> 'D';Box �Z+O ' Type Filter Matari ,Depth' Filter <br /> Distance to nearest: Well _fa.__.. Foundationd `�Properfy�L(ne .... <br /> SEEPAGE PIT}' J €Tepth "' ...... Diameter Number,............... <br /> Rock.Fi!!ed _Yes p N <br /> fable Depth. _ Rock Size: <br /> istance to nacre,t: Well ..__. Fovndatfon Prop Line �tk <br /> REPAY DiTiQtii 1prcv"$,nitation'Penmlt#............ ......... .......... <br /> .; . , i <br /> Septic ank{FS iedf 'R equirements) ................................ ........ .: :_ <br /> Df p s Fie�l7�d,�(Silecify Reguiremenri) ........................ <br /> '� .C::. +e. <br /> r�.. ? e __• •_.__ <br /> _•........................... __ .... __. <br /> II , -�r:..,�"Y'j`•`syv, �' fi ,._�'.IDraw existing and required addition or,reverse side) -. .' ; <br /> llf <br /> N. <br /> 1 M I}�•`1 1" . J ., i YJ - d1 <br /> !�$kiebNp certify thit I havepreparecl tisls;appilertion aril'that tiu �N6lic'wil be,dons in atceedama WiHt 'J Jestqul <br /> t ovMy Crdla+anas ata i Laws, soil holes and Regahltions of the San Joaquin local Health DlsMct Hatni owttee er>ICara- <br /> sadyag6atl4111 /ltlrre ias fles tiN feiieStlVin t':: :K, y <br /> " sorMfy►hct in thrperfonnak of,the work for whkK'th'Is permit is Issued, I shall net employ any pw en in coal stsirnrter <br /> ai'`to beconio!U eCt t111.1w"^rkmar►f Cotnpeef"o iaws of California." <br /> alifornia <br /> � G'�',s�,bcti. <br /> Sign .. .......................... Owner, <br /> 8y= r t.... : title <br /> - (If other than owner!.fir - i w hR <br /> lrOlt 13EPARTMENT USE ONLY s"°` •: <br /> APPLiCAT(CaN AC PTED`'BY::` .. _ .................................. <br /> .. DATA l.•Q_:-�3� �y '` '` t'�n <br /> . .BUlLDlNG PERMIT.;ISSUED :......:....:.:: ......................................................DATE::.... <br /> ADDITIONAL COMMENTS ....................................:............:.._.............._ <br /> ....................... ....._..........___•.--•---..___ ...... ...................... ........................... <br /> .... .... `1j'JJy. <br /> �,*'Final <br /> , •.. ........•......................................................... ... f <br /> �i <br /> Final Insipection by:`: Date . . f ...7' <br /> p �. , a .SAN JCAQUIN:LOCAL�HEALTH DISTRICT <br /> yrs�„+y <br /> Y.r , s{ <br /> E.H.49 1•b8 Rev.5M <br /> �.`. uwr�sru �*�+.+y.wr.,•Wir.� , <br /> •�, �`S �� -mar-wxr'V,.Y�.il .+. _•'�'4�aR���rS� "I + <br />