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FOR OFFICE USE: A"LICATION FOO SANITATION iNWR q <br /> Permit No. ..71.�F•�� <br /> .. Mem►Ieb In Triplicate). . . _. Date Issued <br /> ............... <br /> _... <br /> TM,Penalt UPIM T Tee From Dab laced <br /> Applkat;on is hereby made M the San Joaquin Local Health District for a pem+lt to construct and install the �sMteln <br /> compliance with Couroy Ordinance No. 549 and existing Rules and Rego <br /> dewibad.This application is mode In come S--CZ) <br /> /�� Eo .-t �ViLr.R.e�,y._. .. .................... . * -...._--- <br /> JOe ADDRESS/LOCATION ...MJ .. .. .. . ..... .. ... <br /> Owners Noma S ![ .... ....cov.N. . -15x- --� 1/8. ..........._. Phone ...._._...._.__..._..� <br /> City <br /> Address ................. <br /> License f ;ZZr57(.4.. Phone ..........._.._..._._._. <br /> Conhoctor7 Name <br /> Installation will serve: Residence❑Apartment House D Commercial❑Trailer Court r D OM r <br /> Motel❑Other. F0.h....CT0LF....00 U-`6 E R E <br /> -•--- <br /> Number of living units' . .. _ Number of bedrooms ............Gorbogo Grinder ............ Lot Size ..ARPrivate E` <br /> I Public System and name ..................... ........—..................._................. <br /> Loam.........-aay Loom❑ <br /> Water supply: Y Peat :sndy ❑ <br /> Character of soil to a depth of 3 feet: Sand Silt❑ day <br /> Hardpan 0 Adobe 0 Fill Material 1VO .If yes.type ..................._....... <br /> f lot, location of system in relation to wells, buildings, etc. must be Placed on reverse slide <br /> (Plot plan, showing fixe o .) <br /> ` <br /> it permitted if public sewer is rsvalhbla within 200 feet,) �� r <br /> NEW W MALLATiON: lNo septic tank or seep/ogvp pe t/X�Q y.5� Liquid Depth ....... <br /> ..............._. <br /> SEPTIC TANK 1 Size....77.... .. . . .--. <br /> PACKAGE TREATMENT ( ) D rtrrtantf .._�� <br /> Capacity l�O. . Type e B�prMaterlal Q7NCR'C'Fle.r Compo �_ <br /> • ...- - •/D . <br /> LEACHING LINE No. of Lines / Length of each line <br /> J�!. _. Tocol Long* �,....Ar.Q...�.._... <br /> pp O G iK. Depth Filter Material <br /> _. ._. .. .................... <br /> p' Box YEs Type Filter Material n <br /> . Foundation . Property line ................... <br /> _... ` <br /> ............ .. <br /> I Distance to nearest: Di Rock Filled yes ❑ No G <br /> ( Depth ... .. .. . Diameter . . _.. . Numbr . . <br /> SEEPAGE PIT ( ,, .___.Rock Size . <br /> Water Table Depth - <br /> ....-Foundation ... ... .. ..... . Prop. Line ..._..__.-_...—. t <br /> Distance to nearest: Well ._ \ <br /> RE►�(Prev- Sanitation Permit I ... . .. - <br /> Don .................................1 <br /> Septic Tank (Specify eq N . � �V.......W�.Y+ ........ <br /> r Requirements) - - - .•..'•""'L ' <br /> Disposal Field ISpec'fy . ............................... ... <br /> ......- . . '- _. . . . .............._ .... <br /> --'-' "- (Draw existing and required addition on reverse side) <br /> will M Bene in <br /> 1 hereby certify that 1 have Prepared this app"catien and 1be- the workistwith San Jeegetn <br /> County ordinanres, State Laws. and awl" and ReggWom of 1M San Joaquin Leel Ill" District. Herne owner K "core• <br /> accordance H <br /> sed agents signature certifies the fellewleg: this permit Is isseed, 1 she" net employ airy r. M porsosuch mamm <br /> --I certify that In Hee nc <br /> perfermoe of the work for which of Califemia." <br /> a' �n�psallM WW' "X <br /> Cot" axon a <br /> ,! / e`Ca owner <br /> Signal <br /> ey <br /> W <br /> XQC�L +IL 7itie <br /> Qf other than owner) <br /> . _FO_R DE►A!T -I _USE ONLY /^2 2 - 7Z-- <br /> _ --� p _..._ DATE <br /> APPLICATION ACCEPTED By i s R`Q DATE <br /> IUED <br /> gppD!ONAL CONG PERMIMAISNTS „ PJ(i <br /> IZ -7�$AN JOAO <br /> � Do,eFinal Inspect)Maby;. I HEALTH DISTRICT <br /> E. H 0 1•'68 Rev. N <br />