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.. ............�f....... ......................... 'L- I APPLICATION FOR SANITATION PERMIT .......... I� (complete I i 1' P n Triplicate} . �i �' /� j Permit No ,/. .. This Permit 4.. i:xplres t Year From Date issued Date Issued Application Is hereby made to the San Joaquin loco# H de cribed. This application'`is`made in compliance #th`County Ordinan No. 54 o co existing o Health District for a Perm to construct and install the work herein T�ZJOB ADD".. .S�c' r ng Rules and Regulations: «._ -� 4" , 1 Rf5S/LOCAT ON � Owners Name °�. ........... ......... .......... S ..S ...10—CENSUS TRACT A;Id essw ...lf l2 --•_ -•.....----••.......... ... .................. ..._ .Phone .... 1 7 4�/ ... 1. � ... ..... <^ .,. Contractor's Name =:::.::.__....._..-...."" -P City :: Installation will Lhnsea�'�-� "�� .. Phone 7 serve' dente ' Pho6 J% Q Res# ❑Apartment House 0 Commercial oTraller.Court 1 Nu I Motel❑Other # vngunits.•.. .ulJ- *EI Number i of bedrooms _...7"rbag$ Grinder I Water Supply: Public System" _ I� ',and name . Lot Size ........... ..•--....._........_....... _ Cho racter of soil to a depth of 3 feet. Sand}]. Silt❑ ................................:..... .............. I..................•.......private , Clay ❑ Peat[] Sandy Loam ❑ 13 Clay.Loam Hardpan Adobe L7 Fill Material .... If yes,type ��. 1Ploti�plan, showing size of Trot, location of system In relation to wells, buildings,,;etc. must , NEWIINSTALLATION: be placed on reverse side.) (No septic tank or seepage pit permitted if Public sewer is available within 200 feet,} PACKAGE TREATMENT �� } SEPTIC TANK(] Size . .. ..............•--.... E Capacity 1Z , .._ T liquid Depth ... ....... ••. ,I Yi' -64 Material..�.v'r r. No. Compartment Dista; to nearest: Well ::~--: .�- � r ............. Compartments LEACHING LINE I ................ .Foundation C.71.............. Prop. Line ., hQ No. of lines .... ........... ---- -••--- Length of I� each line........1. •. ........ Tot I l . - p_ �� a Length. .5 D' Box ...!�.... Type Filter Material I Distance ( "--•••••Depth .Filter Material ' ........I....._; Ei �ce ton Well .....:.......... SEEPAGE PIT serest .. . .....-_ .. Foundation /a r ....... Property .� f- Diameter Depth � .....:_ Number '(. R�k Filled yes e WaterToble Depth .-.-,Rock Size Distance to n`earest=Well Txy .- , om .. .. ...foundationREPAIRApDITION 1Prev. Sanitation Permit Prop. Line .. ................ . ............... - ....---•--_..... Date ........---= ..._.....Se tic Tank (Specify Requireents) .:: : - Disposal Field (Specify ......_..... I p fy l?eq.0#reri�ents) + f ....... ................ ................. _ ...----._...--- .......................i� ...................... ----....----••••--•-••....................••••-•-- (Draw existing and required addition on reverse side) I hereby Certify that J have prepared tills application . Caun Ordinances, State Laws,' and Rules and Regulations nstof the San Joaquin Local Heat h.0:N. Honor o San Joaquin tf►,4 be clone in sed agents signature certifies the following: owner or liven- q "t certify that in the performance of the wank for'which this permit is Issued, i shall not employ arty'person in such manner as !o become subject to Workman' s Compensation laws of California." Signed .�.. ii J.................... . ....................-------• ---- Owner .. ----- ----- --•--- Title hf oche tan owner) FOR DEPARTMENT USE ONLY PPLIC --i- ems.F!=----.. _ :... r �. EPTED ------------. ............•_.. DATEi. -:7 ':...: Al . BLItLDINGi�RMI CISSLiEDB�..�--•-- ---- -•----- •---•............. .... .. ..... . .... . IF : VI Eur..... . DATE ...... _. f ADbIT#ONAL COMMENTS . � �i :_.: p:: WnrSENb.... .0.��`:. ! I.......---•---•----- . ----------- -- •------•- -•-----•--- --.... . Fina! Ins" ------------ ------------ - ------ --- !'' ...............................•-- .....-- EH Date 13 h —6 v• SAJOAC,UIN LOCAL HEALTH DISTRICT �.� I u 8/7h 3M II ,