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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Perron No. ...7L'w0° <br /> (Complete In Trlpllcate) <br /> ...... .. . This Permit Expires 1 Year From 00%Issued <br /> Date lowed <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to comfnid and Install the work hMNn <br /> described. This application is mode in compliance <br /> /with County Ordinance No. 519 and existing Rules and Regulalkm <br /> JOB ADDRESS/LOCATION re N^ 3 /� (i(''.� r rra c CENSIK TRACT ... ..... <br /> Owner's Name �o Z(V.f bPC...h.." .t.................. ..... Q.. ....phone ��`/" ..rr 7... ....... <br /> Address G f3eY !l/4 . .. .. ..............City y oc.tK.fQ» <br /> Contractor's Nome _ 3c/.C. .. .. ..... ....................License I ....... ................ Phone ....... .................».. <br /> Installation will some: Resident*0 Apartment House C] Commenclal❑Trailer Court Q <br /> Motel C1 Other ............................... <br /> Number of living units: . ..I.. Number of bedrooms ............Oarbope Orindor ..... ...... Let Size —r-r n......................... <br /> feWater Supply: Public System and name ............................................................................................................Prhra �, i <br /> Character of soil to a depth of 3 feet: Sand❑ Silt[3Cloy E3Peat®' Sandy Loom C3 Gay Loom t3Hardpan❑ Adobe ❑ Fill Motorial ............If yes,typo............... ............ <br /> (Plot plan, showing sire of lot, location of system In relation to wells, buildings, eft. must be plowd an reverie Ude.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 400 feet,) <br /> PACKAGE TREATMENT ( I SEPTIC TANK" Size.........� ................... Liquid Depth ......................... <br /> Capacity /C00 .. . Type .................... Mater{ol...................... No. Compartmenh ...................... <br /> Distance to neorestt Well ....................................Foundation ...................... prop. Line ...................... <br /> LEACHING LINE ( I No. of Lines . . . length of each line . .... Tota length <br /> ............................ , <br /> '0' Box Type Filter Material ....................Depth Filter Material ............................................ <br /> Distance to nearest: Well ...................... Foundation . . .. ............. Property Line ........................ <br /> ( 1 Depth ........ xSOr .. ......... Number 1'............... Rode Filled Yes a No O O- <br /> Water Table Depth ................�............................Rock Size ... <br /> �(,�j�C Distance to nearest: Well .......>So....................Foundation .... .1.0....... Prop. Line .. . .......... <br /> REPAIR/ADL ON IPrev. Sanitation Permit# ............................................. Date .................................I <br /> SepticTank (Specify Requirements) .......................................................................................................................................... <br /> Disposal Field (Specify Requirements) ..................................................................................................................................... W <br /> ........ ................. ... ........ ......................................... .............................................................................................. <br /> ............................ ................ .. ............... ....... .................._............................................................................................ <br /> (Draw existing and required addition on reverse side) <br /> he+eby certify that 1 haw prepared ►his application and that ►he work wiM Ise done M aaenleace whb fan 1eM01M <br /> County Ordinances, State Laws, and Rules and Regulations of the San Jeoquin Local NeaMh bleldet.Mettle owner or New <br /> sed agents signs certifies the followi <br /> "I certify t performon t Wk for which this permit is issued, 1 shall net employ any person In such manner <br /> as to t in Hon laws of California." <br /> Sign ......... Owner <br /> By Title <br /> (If other than owner) <br /> _ T! DIPMTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE 1O• -7e <br /> BUILDING rERMIT ISSUED ...... . ...... DATE <br /> ADDITIONAL COMMENTS _ _ . ..... - <br /> Final Inspection by: <br /> �_ ���-�....�' `.�^:... ...... <br /> . -rte Dote <br /> EH 13 24 1-611 ltov. 5M SAN JO QUIN LOCAL HEALTH DISTRICT 9/74 3H <br />