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<br />SAN JOAQUIN LOCAL HEALTH DISTRICT
<br />f8.5 21677 $16V. Ai74 3441
<br />... This Permit Expires 1 Year From Date Issued
<br />Application is hereby made to.the San .Jooquin Local Health District for a permit to construct and install the work herein described.
<br />This application is made in compliance l.with County Ordinance No. 549 and existing Rules and Regulations:
<br />JOB ADDRESS/LOCATION ,C2/ er6 7-re-6-M64J • LA4 •61- CENSUS TRACT ..
<br />Owner's Name..6/tee- Ave4e7p PiitesiefAi6- ... .Phone \\. ..
<br />Address %oa f.& /4(7 -7"-L6/014-/Li .City
<br /> Zip
<br />. License # 491-11-3V3 Phone
<br />'''3;6-o'rYlm;"rcal"
<br />Motel 0 Uther. .... .... ................ ... .... .. •
<br />Number of liVing units: .... „„ ..... , .Number of bedrooms Garbage Grindef.,....'Lot Size
<br />Water Supply: Public System and name ... N. ' \ -\,„
<br />Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay 0 Peat 0 Sondy,.Lacr 0, Clay Loam
<br />, Hardpan Li Adobey....: Fill Material . ,... ....If yes, type., ..... .. 2:: ..... `.••••. ... .
<br />_ _ -.. - ••••. •••.•
<br />iPlot plan, showing size of lot, location of system in relation to wells, buildings, etc. rnu‘st be placLi on reverse side.)
<br />NEW INSTALLATION: (No 'septic tank or seepage Pit permitted if public sewer is avail'able-within 200\feet,) •
<br />3-1
<br />PACKAGE TREATMENT f 1 SEPTIt TANK Ite- • .....'".""e-Size . sr--./X20 ''''` Li -,. . -, • quid Depth
<br />Capacity ,..0.0.C.77‘.,`7-•Ty1.pe R 6C,7:.... , Material COA)C- No:: Co'r'n`p;rtmer-nts.• • '',.
<br />. 1.,... . „.., ,.., , , N i 7, N /14
<br />Distance to nectrest:"•Well7— —........ ....... Foundotior c-' s i'.... \Prop, Line
<br />LEACHING LINE is.,r No, of tins ..? ter* of each lino......./.0.‘' ... .: TotaisLength , • I%
<br />_
<br />'D' Box...if!"..„Type Filter Material ... _••F7 '.1‘;„ .... Depth Filter Material .. .... /.a.'N., .., ..... „ .. ..'n .... ..,_
<br />. .... '.) , 4 P roperty
<br />SEEPAGE
<br />, N,.. \- '.
<br />Distance to nearest: Well
<br />. Foundation....A ... -_, .. 7.-.7:.....roperty Lille ... ...... . A. ..... ....
<br />. ".. '
<br />SEEPAGE PIT 1'" Depth 02-r` Diamei; --?6 " 1 Number 3 —6-- \-,,iiock 'Filled • Yes, NOZ
<br />Water Table Depth ' V' Rock Size 'i 34 "\ )( i / 2'.0 'N '''.
<br />
<br />Distance to nearest: Well ' .
<br />
<br />Foundation /4' .74s \. Pran 'o .' i; ' ..•,ie .,. t .---" • r
<br />REPAIR/ADDITION (Prey. Sanitation Permit # ' a Date....'71 <-- N. ....
<br />$' • \ % \
<br />Septic Tank (Specify Requirements) ......1
<br />
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<br />.. t' . • ‘ Ihi.\ ' N. ..IN,
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<br />.4. ..., -.. .‘. . ,...
<br />this applic'ation and that the work vvill done' a cordanc cr."-` w ith San Joaquin Coun
<br />"I certify that in the performence of
<br />yy. ........ Y.
<br />
<br />FOR OFFICE USE:
<br />............
<br />...........
<br />APPLICATION FOR SANITATION PERMIT
<br />(Complete in Triplicate)
<br />
<br />FOR OFFICE USE:
<br />Permit No.71 3 g?
<br />Dote Issued...:-/.5.771.
<br />Contractor's Name..... P/9•0,24,5-4(/ „50,1,,,'s ..
<br />Installation will serve: •-•-•
<br />
<br />Residence E Aparith•fen4Houe 0' railer Co']"
<br />.....
<br />...
<br /> Private L.,
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<br />1Z!
<br />Disposal Field (Specify Requirements)
<br />•
<br />.(Draw e?9,sting and required ocidition on reverse side) NN
<br />I hereby certify that I have prepared
<br />Ordinances, State Laws, and Rules
<br />signature certifies the following:
<br />to become subject to
<br />Signed
<br />By . .
<br />(If other
<br />APPLICATION ACCEPTED BY ...... „
<br />DIVISION OF LAND NUMBER
<br />ADDITIONAL COMMENTS
<br />..„ ` • N,
<br />WorkmCompensatio—i—It avf California."
<br />Owne-
<br />trr'le-tr---
<br />n owner) a t ‘. \
<br />. "1 % \ \ .S.' \ .,,,,,, 1 '
<br />FO DEPA TMENT US NLY
<br /> DATE \ ;-„4-
<br /> , 7 ' ''' ,
<br />DATE _ .. :N..N. .
<br />. .., . :'.N. 2\.
<br /> „. ........... _.... . • , • ••••, ••
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<br />the work for which this permit is issued, I\14halt noiseteraplay•artroersan in such manner as
<br />and Regulations of the San Joaquin Loca\11:Iii•al-thiDis\iT-i'd; tilame‘OwnNWir or lic'ensticis::agerits
<br />N
<br />Title...„ ...
<br />.......... ........ .... ...... . .
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<br />Final ,Irisp
<br />ES 13 24
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