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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT" :.................... (Complete In Triplicate) Permit No 2� ......................................................... 9;�• - - Date Issued:?�................ ....... .. . . . . This Permit Expires 1 Year from Daw Issued ��. -y__,1940 r14rvGa 0_40.:_ �� VSs 3lco- 03. 8�d9 �4, " •e 94a sq ApplicarIs'hereby made to the San Joaquin Local Health District for a permit to construct and Install the work heroin described. This appI ati Is_made in compliance'with'County Ordinance No. 549 and existing Rules and Regulptlons: .TOB ADDRESS L ATl a �•� )IOC Olii .. ,� . :-.�• °� qt" TRACT .. ... .......... . . Owner's Name ............... .. . ..... ....... .....Phone �...,...,. Address ._._ la ...:.��K� .t. �......... ....... ..IC, :..........:.l� ...... Contractor's Name .._..,_. ...... .... .. ... ......... ... l xt .........;;. .:........license#2 Phone Phone T. ..r��a,�l....... Ipstgllo0on will serve: Residence In Apartment House flmerdai CJTrailer Court 0 Motel Q Other.� k� ��- �—: . Number of living units,....'..,:. Number of bedrooms ..1........Garbape Grinder ............ lot Saxe ..... :......::.:.. Water Supply: Public System and name ..+ .... .. ........ . .............. .. .. .. ...........................................Private , Character of soil to a depth of 3 feat, [Sand E3 Silt C3.{''CJayY 0.•, Peat Sandy Loom Gley Lown JM . Hcrdpan(� Adobe Q AN Mcasrial............1f yes,sype............... ............ (-Plot plan, showing sure of lot, location of:'system in relation to wells, buildings, eta must be placed on riverse side:) NEW INSTALLATION: (No septic tank or seepage pit permbW It public sewer is available within 200 feet,) PACKAGE TREATMENT I } SEPTIC 1ANKSits.. .-s'r,.f X.. ............. .........:. . LIgWd Depth ... �r..... Capacity Type ... No. Comparsrrtettts ..:..........1 .. Distance.to nearest: Well _.4-490.1.f.. :..:.� .foundation .. ..d�.`... ...PAW6 Line... ..: :.... LEACHING LINE . No. of Lines .._.1.. yJ ............... tength 'of teach lwn .......`? ... ... .. ToUdLength ..A.7Q............. •�, Box ` .. Type fitter Material I.I , ,,.:.Depth Fitter IlAafeAal . .�sS'.....�.....:......: ........:.:. Distance to nearest, Well .I�tJ.�: 1 ... Foundation _./-Q-31........ Property ).Mie ..:�..............:. [ 4 ... Oi*meter ..........:..... Number ........................ 1Wdt Filled Yes Q No SEEPAGE PIT Depth _- . . Water Table Depth .... .......... ...........................Rads Stu ... . ......................... C� ...tet..: f ....Foundatlon ..r........:.:: . Distance to nearest: Well ... .... ....._ .... Rrap. tine :..................... REPAIR/Al101TIQN(Prov, Sanitation Permit# ..... .. .................... Date ................... � ...:..__I Septic Tank (Specify Requirements(......................f -• .......................................................... . ... ...... ....._-....... n Disposal Field (Specify Requirements( ............... -•-------.•......... ....................... .... _ _........................... ................---.......... .... 3 ........__... .............................. ........... ..... ................ .. . .... ..........._..................... .,....... . (Draw existing and required addition on reverse side} .. .. .. ...... . .. . . I hereby certify that 1 have prepared this application and that she work will be done in accerdance with San Joaquin County Ordinances, Stale Laws, and Rules and Regulations of the San .faaqulrr Local HoaW District. Moate nwoor or lice* sed agents signature certifies the following: "I certify that In the performance of the work for which This permit is issued, I shall not employ my person in suds sisartaer as to become subject to Workman's Compensation taws of California." Signed ......... ..... ..... Owner � ••- �f c•�J :.'title "C ' By _._......._ .......- (If of r han owner] FOR DEP TMENT USE ONLY APPLICATION ACCEPTED BY _____________ _ .�� ------ -- ,---- - - � ••--- ---- ----- ---- --- - -- ---..__:----....--...;-...--;------- DATE,.,..-- -t:�.�.� 1�7G' :._.: BUILDINGPERMIT ISSUED ..__...•................ .......... •----- ------ ......................................................_DATE ___-.......... :.._...------•------ ADDITIONAL COMMENTS ................. ........................................ :..........:... ...................................... -- ---------- -- ..........._...._...-......_....__.._..,.......... Final Inspection by: ..---------• '... '"................... .. ........ . Date gt 13 2ti 3-68 Rev. � ' - �._.. . ... .. SAN JO QUIN LOCAL HEALTH DISTRICT 8/7h 3M.