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M. <br /> w II II <br /> "'. FOR OFFICE USE. <br /> AP►UCA <br /> Tt Kilt sANRAN ►ERM T <br /> In <br /> ....... .:.... Two lesmolf Exrlru T Year Frwa Daft lose" <br /> a Applicolion is hereby made to the San Joaquin Local Health 011trict for a permit to Con <br /> sMuct ands <br /> desalted. This application Is mode in compliance with County Ordinance No. 519 and existing Ru1M""raNdSR <br /> . , JOB ADDRESSILOCATION :..4775- E...Woo.dbr.idge .RB., _. C§MSLIE tRACiAcamRa <br /> Owner's Name _Gus.-Ma3enhoffer _.._....... <br /> Address Sane . ._ ...... City , _ . . <br /> . _ .: <br /> �r <br /> Contractor's Nome .G..d. A...SpptLe...Tank...Ser.. . ...License to 3.0-.a7 <br /> Installation will serves Residence"Apartment House[] Commercial❑Troller Court ❑ <br /> Motel 0 <br /> Number of livl,ng uMtsi... ._ Number of bedroomsGarbage-Grinder Lot Size <br /> Water Supply, PuPublic and name ........................... <br /> .. .. . •••• . <br /> i <br /> Charattor of soil to a depth of 3 tech : Sand❑ Silt❑ .Clay ❑ Peat❑ Sandy Loam C3 ' Clay Loans Q'+s�' tet .. z,. <br /> Hardpan❑ Adobe❑ Fill Meterlat .... .. ...If..yes,Type <br /> (Plot plan, showing size of.lot, location of system In relation to wells, buildings, etc. must b6`plaoed.an fNNfnM "iL <br /> 4 k.i d••. y l'4�4' <br /> NEW DiSTAllAT10H, ' INo septic tank Or seepage pH permitted H publk newer U avall0bb wNh6y'J?�1t3 <br /> PACKAGE TREATMENT ( ] SEPTIC TANK[ ] Size WWd+�P!h <br /> Capacity .. .............. Type Meterl0l .... .: No ComparhneelM <br /> y., N tJ 2^� vx <br /> Distance to nearest. Well ......................_ Foundation ... : Prop Lkr : - <br /> LEACN'NG LINE t ' No. of Lines. ..... ... Length of each line.... ..... Total <br /> 'D'..Box Type Filter Material .. ...... Depth Filter Mafertal <br /> ,LYS:u,.atv�iKhf1,!Tgi .: . <br /> Pr t; LMe� .... <br /> Distance to nearesh Well .._ ' .. Foundation -. ^' <br /> s; a <br /> SEEPAGE PIT Depth ........ . Diameter Number . F)Iledx <br /> P Rock Size --..... ` <br /> .: Waren Table Depth ....... ...... ...... : . .. ..... -- <br /> Foundation .............. <br /> Distance to nearest, Well .. . ::: .... ►roP <br /> 2 .. <br /> REPAIR/ADDIYION(Prev. Sanitation Permit sF .. ..... :. .... Date <br /> Septic Tank (Specify Requirements) ................................ .. ... . .. . <br /> Disposal Field (Specify Requirements) 70'.. 2aach. 1ine with stllDmp 4..:..Xida 12;.:SdaeSt and k <br /> . . .. ° C.�..... __.... . . ... ... . t <br /> ... :. :............... <br /> (Draw existing <br /> and required addition on rtvarsa aide) <br /> I hereby certify.Mat I have Prpared this application and that rite work wgl be done M accerAnrla wNY,lan <br /> Csioaly Ordinsanses, State Laws, and Rules and Regulations of the San Joaqes <br /> uln Local Health DkMkt Nee wince M NedF <br /> s t'-3 ps6ti m c sifies 1M following: <br /> 1 pr1Uy Nsaf in the perform,, of the.wark for which this permit Is Issued, I shall not *'"Ploy any pecsea ht-saeA nssaaa�r T b <br /> s»M►eoetee subject ft W n s Com s e ares of CalHemla.^. <br /> - <br /> • Signed. ... - . .. ..._ .... . Owner <br /> BY _ p _. _ . . Jn1e ..OVmer•- G _t ^ertic Tax" 5er, a a e an owner) x <br /> pfd >k v <br /> FOR DEPART ENT USE ONLY _ <br /> .*, APPLICATION ACCEPTED BY ... .... DA <br /> TE Io <br /> BUILDING PERMIT ISSUED..:. ::..._: .. DATE 4 <br /> !�S ADDITIONAL COMMENTS...... <br /> i <br /> Y_ ... .. ... ...... . .. .. . . .. - .. <br /> ,. .... . . ...... Dain I�/r"v/f• t: <br /> find inspect on by '- " "' " ' / <br /> ;! ~ <br /> f„i 13 24 1-613 Bev. 5�4. S J AQUIN LOCAL HEALTH DISTRICT 9/71 3H <br /> f <br /> �J <br /> i�iL� N >i�•> "7A'.rr�.•isy,k�al�i�,ro�..{�" �' .,^�.o-t .�'reel"..51a"t:�&b?�Vt, i'a�ss.l .�ren,�, - # f<ar_,. : <br />