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FCR COW/ICE USE: <br /> 1� •� !,r.r I1PE'IiCATION FOR SANITATION PERMIT <br /> ,/` �� � Per•nit No. <br /> ...f� (Cewepieh in TdpiicaM) /�J �c2 7 <br /> C"iCf Dora Issued ^v`..IM719 <br /> This remit Exes pir1 Year From Deft Issued , <br /> «��App{iea••a+ .0ernby mote tote San ,oag6,in Local Health D srriec fo• a pern,t to construct and install the work herein <br /> describedrt-.is appi.r-cl,on :s:ss najdee ircccii okaQnca �with County G•d.noncee No SAO and ex,-ting Rules and Regulations <br /> JOB ADDRESSAOCATs h ///-dlR�w(„seiF�ri TAW .f�tilQt�fR"&-" �t. CENSUS TRACT <br /> �/-.. . ._.............. <br /> Ownef'S Na a !/ l •�.1l�1t.Af4 �p� Phone 77 C.'/0041 . <br /> Address (�Ar C.ry `C�y d�.G� �Lpry►a/ <br /> Conhocno,'%Name l"4Mt4.6T dBW' Li rinse A /00VI Phone q".- 07 <br /> Installation will serves Residence !�, ApaHmsnf Housed Ce�rhmerc;a' —Trader Court r1 <br /> t Mo* Cher - .. 9 • jr to <br /> Numbw of Wing un,rs: . .� Number of bedrooms /. Garbage GrWdars . Let Site ./ �JL •� ..... . . <br /> water Supply Public System and name I f .�'C. Private Q <br /> 1 Peat So+id loom❑ Cay Lawn[7 <br /> Chowoeter of soar to a depth of 3 feat: Swed.J S Is_I Cloy ❑ ❑ Y <br /> Hardpan 1 AdoFxe)0 FRI Material .. If Yin.typo <br /> IPlot pion, showing size of lot, locat,on of system in relation to wells, b0dings. N< must he p'ated on fewrse side-1, 1 <br /> MEW MWALtATION: lNo septic tank or se0909a Pit permUad if public seww is available wihh;n 260 foet,l <br /> PACKAGE TREATMENT I I SEPTIC TANK bd Site wf.,x J+ Liquid Depth Sf' . .._..... <br /> Capacity II�Ar&Y/Typo . t -..- Material s• Ne. gnportrnar+rs �'-......-.-. ; <br /> Distance tto newest, Well ..... . Foundation /D. Prop Line -.f ............ <br /> ' <br /> LEACHING LINE No. of Lines I.. tongs,, ofn each line 00 Total length .09.�. � <br /> 'D' Box -0' iype Filter Material 1ST -..Dap e <br /> D,stance to nearest Well Foundation /O a Property line -r .......... <br /> S IT �R I I DepRock Fi;W Yes Me Q <br /> i •h Y f�$/sr�ametar Numbe- / <br /> n�14 - water Tobe Depth _ __..-_... . .Rock Size <br /> Sh� U __LO Prop- Line <br /> f faurudofwn . �..-.. <br /> �� Distance ,* Hooter,. Well _..... ...._ . <br /> REPAIRJADDIT MIPMv. Senitahon Permit♦ Date .. .......... 1 ` <br /> Septic Tank LSpecify Rawrreminisl _ ........._.. <br /> _. <br /> . . ........... :. ... . <br /> Disposal Field (r+PeahpecispininsaW4 . <br /> (Draw existing and tequirad addition an rase s;del with Saw /eegaln <br /> 1 hereby cer%h that 1 have Prepared tAs application tad,tbe► the work wIN {meed rutHealth District Hawn ehwner or quire <br /> County Ordinances, Stat* laws. and Rutes and Regvlosews of the San JealaM <br /> R0110- <br /> sod otters signalers cit"ifist the foflewlnY- <br /> in such ma caner <br /> ••1 certify then in she pe tarmonce of !M wook For which this parwsit is isswe 1, 1 shall not employ a" parson <br /> as to become subject to Wetkraari s Camps"Is"n lours of ColiferMe.•• <br /> Signed ... ^-•_ns O�nar <br /> g.� <br /> �� /L.ILfiFKAa 7it•e <br /> IIf other owned <br /> r L DVARTMMT UP OMLY ------ <br /> ^' DATE <br /> h APPLICATION ACCEPTED BY DATE <br /> BUILDING PERMIT ISSUED <br /> ADDITIONAL COMMENTS - <br /> r s <br /> h 5-71 t <br /> Date - <br /> F:nbl rnspection bY' j�n/►•/9jJV <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H 9 1--6e Rev. SM - <br />