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FOR OFFICE USE: !/ APPLICATION FOR SANITATION PERMIT ..................... ...:.: (Complete in Triplicate) Permit No. .................. This Permit Expires 1 Year From Dale issued Date Issued .. :. f. � Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work heroin described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: .los ADDRESSACICATION .....�(. f .dam:1 .............. Owner's Name . �_ . o ..� I.LYlI�.! /mf.. SSaC CENSUS TRAGI . "..................... Address .... 3..y..j.... � Done ` .G.�nt ............................. ...city../ iGra.�/y.. ,�s . Contractor's Nome _ . � ,� / c.c . u ..a'�:-,.�...................lice►se # Installation will serve: Residence Q Apartment House0 Commercial galraller Court E3 Motel Q Other............................................ Number of living units,............ Number of bedroom.: ...........Garbage Grinder ��Lot Size Water Supply: Public System and nae .................. ,� _ .._ ........ ................ . ...... .Private Q Character of soil to a depth of 3 feet: Sand E] Slit Q Clay C3 peat O' Sandy Loam O ClayLocus E3 Hardpan 0 Adobeb' Fill M6WIal............if yes, !Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. Must be placed on reverse stde.� NEW W 'ALLATIOhh (No septic tank or seepage pit permitted If public sewer is available witt�t 200 feet,) PACKAGE TREATMENT SEPTIC TANK She......... :.X. ..................... . LkWW Depth ......;.�','� parclty ./20. ..... Type �Gtmso . .- MaWW. . std....... No. CompartmrmttN .... .......C4 Distance to nearest: Well ..... . �.............Foundation .. .,�El..`.. .....Prop. Lfne . ......, 'n LEACHING LINE ( No. of Lines ......./.............. Length of each line..-..5-0. ......... Total Length ...L'�?................lG I 'D' Dox 4,,U.... Type filter Material /.�.�.�.�.Depth Filter Material .....I �,......... .. ................... Distance to nearest: Well . ... - .a'x+�•-.... Foundation .�W............ property Llns ..�. � ,a SEEPAGE PIT Depth .... �'�....... Dlamehr `• 1 ' •�-:..... Number ........�................ R� Filled Ypt � Water Table Depth .............6.67./.........................Rack Sire 42��.k.l... .:. Distance to nearest: Weil .../ lsrm.�. .....................Foundation ....l.4P�....... Pmp REPAIVADDITION(Prov. Sanitation Permit . Line ... .... '.. . .. Septic Tank (Specify Requirements)................................... '.. .. ...........Gc�e ................... .... .I Disposal Field (Specify Requirements) .. ................................................. ........_...... .......:. ...............----........ .................. ............. Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that fisc work will be done in accerdaace wills eau County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,,Dislri,d. Neese caner or Rtets, sed agents signature certifies the following: "I certify that In the performance of the work for which this permit is isswd, 1 AM net enpmley aayr in sO&ase>wne► as to become subject to Workmon's-Compen tion laws of California." Signed .._ '?� rL F Owner By ..... ...._.C�. � khan --�� . title owner) _. _. _ FOR EP R ENT SE ON Y APPLICATION ACCEPTED BY . .... ..... ...�-t--5.. DATE ��... �.�,-.��..___.... BUILDING PERMIT ISSUED .,�.................... ADDITIONAL COMMENTS ..... .. ._ .. ... • . •-••-•--•---... _.. % AT......_...... .............................. . .. ... ........ :. Final Inspection by: .. . ... ....-•. 7--C........ EH 13 241--68 iZev. --- ----- .. .. ....................... .._.. .............Date .. �. __.. .. .......... SAN JOAQUIN LOCAL HEALTH DISTRICT8/7lt 3M