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FOR OFFICE USE u APPLICATION FOR SANITATION400M G norm', tla (Complete in lriplitatel 1 f Dare Issued ! ' This Permit Empires 1 Year from Dat*Issued Application is hereby made to the Snn Jonquin Local Health District for o permit to construct and install rhe won: heeeie described. This application is mod„ In compliance with Co%w" Ordinance No. Sao and existing Rules and Regulanant /' �I k� JOB ADDRESS/LOCATION .. /I" � Fel;, Trr CENSUS TRACT _ - - Il+ene .......... Owner's Nome r . .... City.", �. _.._. Address A_/5,.� �,.�_ _�C1c4..... .. .... Contractor's Uon"a I ...... .. Pow" .. ................ . . ... ..... ._... . Installation will server Pes,dence AponmeM loom eananordd Matter Coo 0 motel 0Other ...11..._. ... .....- ...... .. . ....... Number of living units, . Number of bedrooms ...!'� Garbage O*WW --••• IM SIER ^ "^' ' Water Supply, Public System and name ..................._............_.._,......................^..•,�............_. . . ........... Character of soil to a depth of 7 feet: Sand[l Silt Q Cloy Q hof Q Sorely Loaves G Cl"laeTt l Hardpan❑ Adabs Q FII(Morerlel _. . . 11 yet.MM - IPlot plan, showing size of lar, lorot.an d system In relation to wells, buildings. ate. tswo M PNMW M New" /M-) NEW INSTALLATION: (No septic rank or seapogo ph parminad If PuWiC sswet is esneYaNawldtltt"0 bNJ PACKAGE TREATMENT I I SEPTIC TANK I I Sin..... . .. .........._. ..................... UQVW Dook .. .- Capacity . Type .................... Material....................., N& cm0wiwtsoft .... F Distance M n^--est, Wall ......_Founds IM........._.......,^.Pow rim LEACHING LINE ( J No. of Lines ..... LMOth of each line . _.............. .. .. Ud 1MMh 'D' Box Type Filter A4MMld ............. ..Depth FIRM FRaUdal .•...... - Distance to nearest. Well . ..... Fou dohan ... .....—.«..-•-. FINMh Uti .._^'..•"'""."^` y .................. Js SEEPAGE PIT I ) Depth . Dianlow ............... Nwnbr ._._._...^..._. .... S1tltlt IIMd V" O Ne Q • Water Table Depth ... ....._........_...RockOft ....................... j Distance to nearest,Well ................... AM• UM REPAIR/ADDITION(Prov. Sanitation Permit♦ . ...... ...... ..... ........... .... Septic Tank (Specify Regvirementsl .. ...................._.......................... ».... . ..._... Disposal Field (Specify Regviremonts) -- •�� •••� •• •�"`�y��•`••`"""'-. w + '' Q (Draw existing and re ulred swldtttew M teuarw side) I hereby certify that I have prepared this application anal that IAS seam► wW be dare M ecwdeam U46 $aw Jee1111"so County Ordinances, State Laws, and Rules and Regulations of tbS San J0e441111 Deal Hmft Dbm&None ewer or Nam sed agents signature certifies the fellowingt -I certify that In the performance of the work Nr which this permit Is Nsaed, I shell wet Staley suit Peoples attob�astarr as to bec000 subject to Workman's Compensation law" of Cellferwta." s, Signed w_u-:..rc:,. . s.. .�.�. i,. ' __...................._. __._., Owner . Jide -. ..... . ......................... ....... ................. . . ((pother than owner) FOR DEPARTMENT IJSE ONLY APPLICATION ACCEPTED BY �/ ........_. ................- OATR _ .. ....._... BUILDING PERMIT ISSUED . , ��I• /y�• "-' ADDITIONAL COMMENTS % •.<• % .�+sv...a...'�x. aJyll .• ..LTAsAs,O�.w.._..Gc`f►.... _..�•�-- ..'..-�� ........................ .........................._...._......_...._........... . ............_ .... . . .... .. .. . ............................................................. ........ .. . OMs....1..�+ ft► .7 Final Inspection by: . ..... ._............._..............._...........r.... .._...._ SAN JOAOUIN LOCAL HEALTH DISTRICT .H.1J 241•'68 Rev. SM 7/72