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I , 1 ;W= OR OFFICE USF. �- - - _ - ��--- t ISI APPLICATION FOR SANITATION PERMIT . . (Cemproro In TdplleaNl Permit No. .A.:s-7o �. ............................................ This lermit Expires l `Teer From Dole issued Date Issued.6.: .rZ:.�. Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work heroln dewibed. Thss application Is �m._acd-e in compliance with County Ordinance No. 549 and exl;th:g Rules and Regulations, If� JOB ADDRE55/LOCATION ..I�7 .T.(o .. .�,... .IM..R#+T. _-J-.,k �� •...CENSUS Owner's Name ./Y.St�f9oz c.y� �0�.¢dc es . ........................ .. ... ......... .....PhoneAdd .9$2. LSS........ z. Conlo�ro� L.a 5�S ._ S .. m.wa*�Llsf., city . .. . s k, 's Name . �':. .:G........b.RC,1'41O.9.:.. .... . .Lkens s . Installation will some: Residence❑Apartment House Commercial E7railw Court O j .( Motel p Other......................._Q................. rNumber of living units:....:!..... Number of bedrooms ............Gcrba a :3r:nder ............ Loi Size ............................................ x Water Supp.ty. Public Sys and name�J',�, y ta{p me ......................................................._...................................................Private❑ C'horoctef of soil to a clop of 3 feet, Sand❑ Slit❑ Clay ❑ Peat❑ Sandy Loam n Clay Loam❑ d Hardpan❑ Adobe C hill Material ............ If yes,type............... ............ ' NFW NSn, sho ICINalocation cf system In relation to wells, buildings, etc. must be placed on reverse sklo.) f N"INPACKAGE TREATMENT t i SEPTIC tank or seepage pit permitted If public sewer Is eval[aSle witi2n 200 foot,) 1 @ e (Plot Ian, show ENsize ji septic J Size................'-::—::......... - b '......... Liquid Depth .........7=....... ' O ir -city .1c:)0e.... Type C ../ . . . . . Comportments . .........._. nee- 'nearest: Well ...... 4Foundation ..1.6.............. Prop, line...�4............. LEACHING LINE [ J No. of Lines :.. ....._.......... Length of each line ............. Total Length .......................... - s 'D' Box ;.... Type Filter'Material ....................Depth filter Material ......... ................................ earesh Well _�..... ............: Foundation . Proaerty Line ....................... SEEPAGE PIT [ [ Depth Distance .. Diameter Numbor ............ ...........-.. Rock Filled Yes ❑ No I. : Water Table Depth ... ....................................Rock Size ...................... ......... tF i Distance to nearest: Well ..................................Foundation .................... Prop. Line ........._..... IMPAIR/ADDITION(Prev. Sanitation Permitilk ..... . ................................. Date ..................................I SepticTank (SpecifyRequirements) ......_......... ......... ........................................._................................................................ Disposal Fie'd (Specify Requirements) .-.R.1-P..(-R.j�.:........ :Cl.S 1:L^LG .....59eTl.>--.176.01. ......................... G4.Q.:e R._._Ttt�iAl......./C?...'...... ....... .uI? U/.NE...... DllL.TI-,aN..:.......=........ ��..Vl...... �1K ...iZ-......rf3 ...... A.cH,4NGS.,_......... ...... .......... - - (Draw existing and required addition on reverse side) .J I hereby certihJ that I have prepared this application and that the work will be done In accordance with San Jeequis County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Lacal Health District.Hem* ow or liven sed agents signature certifies the following: "I certiF.that In the performance of the work for which this permit Is Issued, i shall not employ any person In such manna as to b.e1 'e . b to orkman's Cofn Jsen ation laws of California.'* Signed ...� �..... ..... .:c%,Z7_ ,.��......................... Owner 1 By .... ... ... .................... ...... .... ... . . .. . . ....__. ?ilio .. ... . llf other than owner) FOR DEPARTMENT USE ONLY ®.�.......�.m�..-._.em,._�.�=j _— APPLICATION ACCEPTED BY � 5NAjE- . ...... ....... .... DATE `L.'7E2 .__.. BUILDING PERMIT ISSUED ..__ .�.. ..... .... .. .._. DATE ADDITIONAL COMMENTS Final Inepectmn by: 4A.. ....Z ._ . . . Date f. EI 13 2h 1.68 Iiov. 51.1 SAN J SAN JOAQUIN LOCAIGfiE•�LTF! DISTRICT 8/7y jM