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FOR OFFICE USE: APPLICATION KM SANITATION FIRM1T permit No. ..74.-'�LA <br /> _ . . . � )L <br /> 1 pais Issued ......-...:.....'. <br /> l Year Fresh Dose heed <br /> ........... This Perrmh <br /> ork <br /> . .ppli. made to the Son Joaquin local Health District for a Permit to Construct and lesion the ictlons In <br /> App,abed. is hereby Mance with County ordinance No. 549 and existing Ruin and Rsqu <br /> desuibed.This application <br /> k made M come n� TRACT <br /> <_ <br /> JOB <br /> JOB ADDRESSACCunoN ...M1/1��E,Ev...-t ../..►..ftl.R.e l . . ..._. ._.Curm �7 <br /> t.7>�/IAC.... .Rte-...CQ.V..... ... .... _C.L.,V..B.. ._.............J...Phone._—.._-------__--------_... <br /> owner's Name qty ... 1..P0_^C ........... _.._�._. <br /> Address . 1 r-C 0.. -.. IiV-11k 'N..y........_......._.........____ . <br /> M VI/E£O E IU S / .License# ;28'S1.e.... Phone ..._......_.._.._._._ <br /> _ Controctor's Name _._._.................. ...................... . <br /> installation will serve: Residence Q Apartment House Q CammOMW QTrWbr Court QOM s <br /> Motel Q Other. FOA....&0... 'O..0-Ke RE <br /> l_ <br /> Grinder ...... ..... Lot Sire ..f)�.RR-b. . <br /> Number of living units. ... . ... . Number of bedrooms ............Garbage -„_privab <br /> I Public stem and name .................... ..............................._. . <br /> .......................................... <br /> Water Supp Y: SY <br /> Peaf rsndy Loom Q Clay Loam Q <br /> Character of wit to a depth of 3 feet: Sand Silt lo ] FilI Material�Q If s, — <br /> I Hardpan Q Adobe ❑ Ye bPe ..............._......_. . <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc must be placed on reverse side.) ; <br /> HOW INSTALLATION: (No septic tank or see it permitted if public sewer is available within 200 feet,) I( <br /> PACICAGE TREATMENT [ ] SEPTK TANK[ <br /> Sir*---yVXla--Y. .. ..... Liquid Depth --•----- <br /> — capa�+*Y IlAo TypaPJ� /�sMattertol.eVNICK. Na. Compamnamri .._ Q <br /> 00 ' re' Foundotlon ../,P__'... Prop.Lire.....5.......__.\I <br /> _ recce to nearest: Well ._. ................. <br /> LEACH LINE No. of Lines / <br /> Length of each lithe . Total length ��..��.'... <br /> DOCS. Depth FIM Material .... lq-----••---•-•••-•'••••'^"”' <br /> •D• Box y6 Type Filter Material .I�. ... <br /> Property Line ........................ <br /> i <br /> Distance to nearest: Well . . .. .. . ...... ..... <br /> Ion <br /> Diameter . Numbs" Rock Fined Yes Q No G <br /> Depth ......_.... <br /> SEEPAGE PIT O .... <br /> Water Table Depth .. ... .... ........ <br /> ........... .Rock Shse . . . _....... <br /> '- <br /> Distance to nearest:Wall .... . .. . .. .... <br /> .....Foundation ._ .. <br /> . ..... . Prop. Line ....................\ <br /> . <br /> . .. ... . . <br /> REPAR%ON(prev. Sanitation Permit+f ..... .. .., <br /> . ... ._ Daae .. ..............................i t <br /> .... ............. <br /> Septic Torek (Specify Requiremenh ... . . . .l _J..'.".�Ef}�Fl... .`/��. .. 36 ..-.... 1 .. _. <br /> Regvirements) .. _ _. ....... <br /> Disposal Field ISpec'fy � ......................... _. <br /> _. . .. _ ........... <br /> ....... - IDrow existing and required oddir;on on reverse side) <br /> I hereby certify Thal I have prepared this application and Min r. twork will be done in accordance with Sen )sequin <br /> County, orennonees, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Herne owner or iicen- <br /> eed agents signature ser ill I"the Y feBesrtngr IFis permit is {saved, I shall net employ any Mreef In such manner <br /> ••I Certify that In the perdernante of tin vicerlr for which <br /> on lows of <br /> asC GlHemte,. <br /> NJ suW L- a+f�man Gm d <br /> �CC� `GG.t-. Owner <br /> Signed <br /> By <br /> (If other than owner) <br /> 2 - 7 _Z <br /> ---. DATE 2 <br /> � <br /> APPLICATION ACCEPTED BY Irl•D - DATE <br /> BUILDING PERMIT ISSUED j <br /> ADDITIONAL COMA-'ENTS <br /> Final Innoectl0n,�7L:- / l!y <br /> SAN JOAOP'( <br /> CAHEALTH DISTRICT <br /> E H 9 1.-68 Rev W <br />