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FOR OFFICE USE, APPLICATION FOR SANITATION PERMIT _ e/ ............................... . ....... ........... ......... ......................... ar(Complete In Tripllxah'r Permit No. .....7 ..! :. . . .• ......... This Permit Expires 1 YeFrom Dar Issoed Date Issued ...s.-->�- 7: :c: . Application Is hereby made to the San Joaquin Local Health District for a permit to consfmi t and Install the work heroin described. This application is made In compliance with County Ordinance No. 10 and existing Rules and Regulationp ) s- JOB ADDRESSAOCATION _...:_ . ..J-..�.7......C.........L...C'.tl C IJ l..r... ;'5.. .................CENSUS TRACT . ......... Owner's Name ................O)J:1.�5:',e. J............ . .l.F. C..I�..S.......... ........ ..Phone .... .......................... �.�/.Q... ............................. Address .. _. ... ...�.J..'7_..'J...7.......f......l..V..!ir....JT1.�..'....kF....City ...0.?ika.W.L....... Contractor's Nome ......0.I.S ....... : ..License �.1.. -k- Pheae`3`.J:.7. 2JfQ Installation will serve: Rssldence lK.Aportment House Commercial 01rallorCourt C3 �+ Motel 0 Other............................................ Number of living units,..�1...... Number of bed ,.r3 rooms ........Garbage Grinder J'.V)... LotSize ....&j(. ...4C.VeS.......:... Water Supply, Public System and name ........................................................ ..PrhfaN Character of soli too depth of 3 feet, Sand❑ Silt j] Gay Peat E3 Sandy Learno Clay loran O Hardpo 'r Adobe❑ Fill Material............If yes,type............... ............ (Plot plan, showing size of lot, location of system In rotation to wells, buildings, ak, must be placed an reveres side.) ' NEW INSTALLATION( (Nose tie tank or page pit rMitted If public sewer Is available within 200 bet,( -•.•..'...»...»') GNt/lt��zc0e pe PACKAGE TREATMENT f ] PT(C TANK{ i e3e Ld f/A e_.LII►�I'r{�,•_..�A.ws!' ..,Liquid Depth ......... �X l J 'r/'t•, J Capacity .................... Type .................... Material..................... No. Com rtmems V tDistance to nearest, Well ....................................Foundation...................... Prop. Line.................i�.». J LEACHING LINE 1 1 No. of lines .....�................ Length of each fine.......y0. ....... ... Total Length Y.Q..�......... J + IU . ,. g� ..... . 1 'D' Box .—S..... Type Filter Material ..!...�...........Depth Filter Material .../..9...7�.......................... Distance to nearest: Well .`a'.�............. Foundation ..../I*....'�..... Property Lim ..X...f......... V SEEPAGE PIT [ 1 Depth ... Diameter 9Q..7..7....... Number .........3............... Rock Filled Yes No Q rr 7Water Table Depth ............ ..tr ........................Rak Size ..rt......f�a.fr/.�...... r v Distance to nearest: Well .......�OO.................... Foundation .Z0....r1f...... Prop. Line ....f*......... REPAIR/ADDITION(Prev. Sanitation Permit sP ... ...... ........:................... Date ..........................-.......) Septic Tank (Specify Requirements) ......... k �-... ......../................,...................._....................................._................. Disposal Field (Specify Requirements) .......�a.c.... -......[.../.. ... .1....... ...i.J.\:f:...............l�.l(.Fi.?5�.�........... .. ................L.(;..../....I.......... z..-,P:f�....Zl....Y..,xf....eels.f-,>'...............1..........................................� \'•(Draw existing and required addition on reverse side) 1 hereby certify that 1 have prepared ''this application and that the work will be dens In seeerdi nse whi Eon County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Leval Health District,Bohm owner or Nese• sed agents signature certifies Me following, ' "I certiy that In the performance of the work for which this permit Is issued,1 shall net employ any person In such manner as to became subject to Workrr an's Compensation laws of California." Signed ...._..........................._... ..._ . ............................................. Owner By.... ... . . .. ......... _.. .... ............................. Title .. (if other than owner) -- bt DEP TIM USE ONLY ' lIJ APPLICATION ACCEPTED BY o/ ,.Z u?G, .. ._._ _„___ .... DATE✓` �-. 7/�. .. . BUILDING PERMIT ISSUED . .. .. .... ...... .... _.. . .....DATE . . .. .. . . .. .. .... .. ..... ADDITIONAL COMMENTS .. .. . ,. ....... .... . .. .... _. .__... .... 1 . . % 14P Ot4HTL y T-1JX.2 Jderp r �r1 � *,00 � lr.ssti 411rA/1 ot..tr. ..... .. .. . 1 in ._ .. ., // :.._ .. . .. .. Finallnspection6y: . �. /. _ ... ... .... ..... Date >/�y�� ...... ... ..... f . . EH 13 2h 1-68 Rev..” AN JOAOUIN LOCAL HEALTH DISTRICT e/7G 3y i 1