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N <br /> FOR OFFICE USE, APPLICATION FOR ,SANITATION PERMIT <br /> �', .. .. ............. .................... Permit No. ...T.J'-.5./r...'� <br /> w <br /> ........................................................ (Complete In Triplicate) <br /> This Permit Expires 1 YeFrom Dat*Issued Date Issued ..1 <br /> ar ..1.... <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work Icor!n <br /> .ti described.This application is/made in cornpHanco with County Ordinance No. 549 and existing Rules and Regulationss <br /> ., JOB ADDRESS/LOCATION ..IYA.114.r�..., /i .Y"..�r'd�n. i .. �./ .��`'. .r.CENStJS TRACT .................... ..... <br /> Owner's Name ..sT xptm .rnd...Q.l..�....r?7F..�..1c:.7...�! �.L�rSr................................Phone <br /> Addres. ., 'c�c.,r .•.L.a.�-r-,a,e..sR'-x'./..r.:.! '......................................city ............................................................. <br /> Contradoes Norco ...�. .�!['"ezlL ...................................y............................ License -30 �. .... Phone . •� ,B.L�C <br /> .. F <br /> ' Installation will serves Residence Q Apartment House 2r&mmerclal QTraller Court O <br /> MotelQ Other............................................ <br /> k' Number of living units,............ Number of bedrooms ... Gar e <br /> // -- / ��jj�• Grinder ............ Lot Size ...............................»..»...»» <br /> Water Supplyt Public System and name ... .sir.C.hsl....e:ed..f.:f.•�, ................................................Private Q i <br /> Character of soil to a depth of 3 feet Sand Q Silt Q Cloy ►] Peat Q Sandy loom Q Ciay loam❑ ! <br /> F Hardpan❑ AdobesIII Material............If yes,type.......................... f • <br /> • F <br /> (Not plant, showing size of lot, location of system in relation to wells, buildings, etc. must be placod on reverse side.) (11 y <br /> a`' FS <br /> NW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> ;r PACKAGE TREATMENT () SEPTIC TANK O size..../.. . Liquid Dopth ------- <br /> 44 } Copadty�� ?!.? Type .�°' :!�»... Material...................... No. Comportmertta ..e7— <br /> .y Distance to Well ... 7�...../. .».......Foundation.../,.........» Prop.lino. <br /> LEACHING LINE ( ) No. of lines .......No. Length of each line ............ Tocol length ..�....._. <br /> •D• Box ...../.... Type Filter Materia) .,Oe.k..Depth Filter Material ....... ...f. . it ` <br /> ' Distance to nearest. Wall �• ? 1 <br /> � ••�..1.��?. foundation ...�.1..�1......,. Property Una . <br /> SEEPAGE T 1 Depth .................... Diameter .......»..»... Number ........................... Rock Filled Yes Q ko»• , <br /> Water•Table De .• a <br /> pth .......».......... . ..».......».»......Jtodc Size ...........»................... S. <br /> Distance to nearest,Weir..»...............»...........».».»Foundation ...».............. Prop. L.Usa ».... .... <br /> a{: RBPAtR/ADDITION(Prev.Sanitation Permit sP......................»................... Date ........».....»».»._......») <br /> Septic T=* (Specify Requirom,") ................. ......»....»....»....... .... ....»»................».._.......:.... ...... <br /> Disposal Field (Specify Requlrements) .......... nssr�-z'G`+�f. ....,, •jP��r...._....».......». ».............»»»».». .� <br /> _................. _ <br /> r.a <br /> ..................�.................................. ........................ ........... ...................»».»........ <br /> Draw existing and required addition <br /> on on reverse side) .» <br /> I bereby ce;fftr that 1 have prepared this application and that tM work will be done in accordance with Sass Joaquhs T' <br /> as <br /> County OnQnanco% State Laws, and Rules and Regulations of the San Joaquin Local Health District.Hoare ownw or)leers• t <br /> sad agents"nature certifies the f*llawings <br /> "I o.—alfa►t the performance of the work for which this permit is issued,1 shall not employ any persons In such t <br /> - as to bete bNet to W •s Tereus of California." <br /> i. <br /> �Signed <br /> .. .. ............ ................................................. ...................................................... <br /> j (If ether than owner) » "... ' <br /> sf FOR PARTMENT USE ONLY �I <br /> APPLICATION ACCEPTED BY DATE....... ....'. <br /> BUILDING PERMIT ISSUED................................................ .................................................. ..GATE. ..».... 1 <br /> ADDITI7NALCOMMENTS................»............................»:»:...........•.:.».................................................... -..........................» . ......... ..».»....» �». »�.»:� ' <br /> Final Inspection by .....': » ..... : , t ..............................»....».......»....:.. •».:»........»- ...» <br /> ....................................... Dote ^.. �•�.�.. . <br /> a , SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ,+ E.H.1.3 241••68 Rev. SM 7/72 3 M <br />