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.................�........................... SANITATION PE1: (complete in Triplicate) Permit No. �S_ f ._....................... Ilii.permit Expires --• - _ 1 Year i>=som bale issued Date issued pplicatian is hereby made to the San-Joaquin Local Health District.for a permit to construct and 1 :scribed. 'Phis application Is made- in compliance with.County Ordinance No.r' it t and existing Rules and Regulations: he - Install the work herein 00 ]B ADDRESS/LOCATION . ocATION ..../ �'/ / . ............:................. Nner's Name .. - erl�C ....:..CENSUS TRACT .p []�9 ...._... dress --I %--'I_•/----•- .L:-- GC.1/ - .. ............................... _.Phone .,. hr.l,.:�? /• -- Qj . _.... -'city . ••.- ntrador's Nome ._G'�f- .._ t C V ��\ a ----------------- ----------------------- -� c oC1C . .�Ra - r-4A - sJ2.....................License #0-0.5 aallotion will serve: ....... ...... ..... Phone � Residence .....--- ---- U'6-artment House❑ Commercial[]Trailer Court ] Motel ❑Other.:_..... mber of living ' • ..............•-- units�..----_-_•-• dumber of bedrooms•, --------- iter Su i �-•••••Garbage Grinder ...-- -- Lot Size pp Y: Public Systems and ......................................... name ..__. - ----•- .... aracter of .....`._..-------•-- --Privvate / soil to a depth of 3 feet: Sand ------•......u....�.......... ❑ Silt❑ Clay ❑ Peat❑ Sandy Loam. lay Loam Hardpan❑ Adobe❑ Fill Mcsterlal.............if yes,type .......................... ,t plan, showing size of lot, location of system In relation towells, buildings, etc, must be placed o M INSTALLATION; (No septic tank or seepage pit permitted If public sewer(s available within 20Q fee n reverse side,} :KAGE TREATMENT et [ SEP ,1 7 TIC TA .. NK f ] Size....::........................... •--••-•• Li ui ... Liquid .Depth Capacity . .........1-711 Type ............. Material---------------------- No, .Compprtments Distance. to nearest: Well ....._.. ... �HING ............................Foundation - LINE ( ] No. of Lines •••••_ Prop. Line _ •--'-- .._..--_.I.,----•-- Length o - fearn line.-....---•--•----•--•--• Total _ t 1 Length -_-•---•---- -- Type Filter Material 'D Box _ ......._..__ C7o --.Depth .Filter Material Distance to nearest .............•• •......_ . Warr � -M,..: 'AGE PIT ............. Foundation I' [ j De ---•...--•-••--•• Property Line r . Depth ............. Diameter .... Number .' . Rock Filled Yes No Water .... Table Depth --•---•--- --•--•---••-....---•--•-•-....Rock Size _ Distance to nearest: Well _.__....._ .................. ...................Foundation p. Line JR/ADDITION(Prev. ••••-••••••-•••••-. Pro . Sanitation Permit y¢•` �--'••-••--•••- -•------•-- --••--- Date ] ptic Wankeci S � p fy Requirements), ....... " :posal Field (Specify Requirements 1-� .................................. ----••-- ....__._.-..._ •---• .------ _]5...............eep 00 -••• '-Ali.--. i.►t? _... -.� �. {Draw existing and required quired aiddition on reverse side] 1 1 .by certify that I have prepared this application and .that the work will be done in accordance with San Joaquin ry Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health-District. Home gents signature certifies the following: owner or Ilcett- tify that in the performance of the work for-which this permst is issued, I shall not employ any person in such become subject to Workman's Compensation laws of California." manner . Owner AA (If other than oryner- )......................•..................-........... Title ..-V -rV�. --"---- FOR DEPARTMENT USE ONLY -ATION ACCEPTED By --, � ING PERMIT ISSUED .... •.......................... . --------------••-------------------------- DATE ONAL COMMENTS DATE . ........................................ ...............................................................................----•----••---.....-.....----------.. ---•-•...................... ................................................ Y' nspection b 1�'......_ •........ ..... ..........:....... ...•......_............--......_.....................--.. 2� 1-68 1jeV. 5M --..Sr --. .. SAN .10AQi11N. LQCAL HEALTH .DISTRICT....-.........Date ... 8/74 3M �f