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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT
<br /> ICompletoIn Triplicate) Permit No. 73.`00.3 t
<br /> Dote Issued ...
<br /> This Permit Expire 1 Year I"Deft Isseed
<br /> Application is hereby made to the San Joaquin Local Health District for a permit to constant and Install the work heroin 5
<br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rubs and 111*900110 M
<br /> JOB ADDRESSAOCATIOfy_ SQ.T ..E.,. rAC+:t7fONT7. . . . .... ........ . . .CENSUS TRACT
<br /> Owner's Name . .. . .... /!:'S.�c....�NN.F.s�t4.!!yf tG ............... ...................................PI1 ..1-/6$�:.v 2,t. ,4--.
<br /> Address .............. ,..........G:v ............................,..
<br /> Conhacter's Name . ... �� R -! .... �...................Llc"w 41c9-�MP.... Phone
<br /> Installation will serve, Residence C]Apartment House Q Commerdal mroll4w Court a
<br /> motel(:)Other / fC��•C.�!4....� �--
<br /> t-
<br /> Number of living units, Number of bedrooms ...... ....Garbage Grinder . . lot Site . ?..K.. , s.....
<br /> { Wow Supply, Public System and name . ........Marr-Q.,n....01r0140.01......._........ ...................... ,.............Pow"
<br /> Character of soil to a depth of 3 feet, Sand T] Silt Q F
<br /> Clay ( 0 Peot E3 Sandy loam E3 0"XIvy loam❑
<br /> Hcirdpon o Adobed3.--Pill MOtetlal ..... : 1 0s}"i,''s
<br /> (Plot plan, showing site of lot, location of system M relcMon to wells, buildings, errt most be placed on mvww stele l
<br /> N1W INSTALLATIONt (No septet tams or seepage pit perm t c! If publie sewer Is available within 200 feet.{
<br /> PACKAGE TREATMENT ( ] SEPTIC TANK 1 ] Sin.... ...............:.... ....... ..... .. .. . Wrild Depth ....................... -
<br /> - Capacity Typo .................... MalMlol.....,.. . No. Compartments k
<br /> Distance to nearest, Well ...........Foundatlon. ... ... ... Prop.Lt" ..........._......
<br /> LEACHING LINE ( ] No. of Lines Langth of each lino ... . . . . .. . Total Length ........ ........
<br /> E 'D' Box Type Bitter Materw ....................Depth Fihw Material ... ..............................
<br /> Distance to nearest, Well ... ..............:..... Faxdatlon .. Propertt►
<br /> ' SEEPAGE PIT (1) Death Oiarrtetr ...............I Numbr . .... .... ... .. A&A F11led Yes [] NO In
<br /> . . Water Table Depth ........;....,..�..............�...............Rotk Sire ....'.,:.......:....,'.;......,. ...................�.
<br /> Distance to neerest,Well FaufWatt " Prep. Lino
<br /> 11111PAI (TION(Rrvv. SqnIWWn Permit* .. .. . ........ Dat, ........I
<br /> Sepik k I Req mental ,.' 0�. . .t•R.. tt4... .. ... . . .......... ..._.................
<br /> Disposal FIold Ify equirements) ,.........��...l�l Vtti.,rr t!^�j``L.......... ... ......... ... ...,... ......
<br /> .... ........ .. ..... - ... i...... ...... .~.. ... .i.�..... :.M.JLI�,\ . .. .. ....... ......... .,. ............i
<br /> (DroW existlnd and►pVinsd addltl0n on reverse tide) W~
<br /> 1 hereby comfy that 1 have preptw'N Mit eppliceMm ear MM the work *M N leas IN sweAerme wb% fest iosomb ;
<br /> tent►Guinea m. Stet laws, end Mei tsar 111"Wedette of the slat A"vla Lead MeralNt Oblrrld.Beata*Wow W OOM
<br /> ted eget slynetrre tertifier"Mowin*t
<br /> "1 tooft shed M the Perfennaince of 60 vretk fw wAkA MC Pernuh N NsbW,l 9W VM emPM errs►NersM to eertM tart A04
<br /> Athon ..... 1........ .TnM(If oth
<br /> _ _ r POR DIPARTMINT UN ONLY
<br /> APf't T1ICA ON 'AOCEPTED IiY.\ .. ..�,� ... .. .. . ,. ......... DAT! . 1Q�. ?'...... ..._.......
<br /> BUILDING PERMIT ISSUED. CVV ... .................... .. . .............. ... .. ... .......OATe. ... ............... . .. .........
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<br /> ADDITIONAL COMMENTS . . .. .. .... .................. .................. .. ... .... ... ... .........,..................... ......... ........ ................
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<br /> SAN X)AGUIN LOCAL.HI ALTH 011TR1C1
<br /> E.H.13 241.-65 Rev. SM 7/72 3 H
<br /> 'r�ygdl411Y'�••`'��1.1'�.i. � ! ree'..... .rw-�-+',it:if+�.Ptr►�..u4^►y,t�r r K�fr1 t��.....�5..�.*i��A'iI'�:�`.`a Jf".:�.�,,,r.�:[e're�.- i.�",_�:�F�:,•�. .. �:. 1..� H ..1
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