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NOW ... FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ¢ i - (Complete in Triplicate) Permit No _ ids•• Date Issued 9�Zr •-��•./. •••--••- ........................... This Permit Expl•n 1 Year From oats bsaed Ap d.plicatlon is hereby made to the San Joaquin Local Health District for a permit to construct and Intall rfh w�I -, described. This application Is made in compliance with County Ordinance No. S49 and existing Rules and.RegulaHetue: r-Ana JOB ADDRESS/LC ON ..21 0.3_ J /� -...,,.CENSUS TRAr .., ' - v R.L. ._9. .. ........ .... a Owner's Nama ... ....1.......... .. �/ ..<� ....aS�'1.I� ........ .: Phone F '^ ''•Address :�/0,3. S. 41*4 1�8... CL✓.... " .,.. CI _ Contractor s Name .....41_..- /2.�'/�-p........ ..............License NYC3,01e... Phone Installation will serve: Residence W Apartment House❑ Commercial []Trailer Court [] -'3. z" Motel ❑Other........................................... Number of !iving units:....if..... Number of bedrooms .3......Garbage Grinder .. Lot Size �24F y Water Supply: Public System and name ........................... - - -' ........_ ..................._......... ........I. ........ Priv r Character of soil to a depth of 3 feet: Sand F Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ s Clay Loam' C' Hardpan❑ Adobe ❑ Fill Material .........If yes,type _ •. s w x Mare '� IPlot,plan, showing size of lot, location of system In relation to wells, buildings, etc. must be plated on reveres std%�`-_� 'y NEW INSTALLATION: (No septic tank or seeps it permitted if public sewer is availoble within 200 feet)� � y . PACKAGE TREATMENT [ ] 3.. `• - SEi`CTANK / SI aX , Liquid Depth z QOCapacity . dd ...... TypfRMteri.o.Id7c%.tV-L- `t��. •w No. Comport ' [ 4 t - Distance to nearest: Well .......................Foundation /Q .Prop.Line LEACHING LINE Pq-/No. of Lines ../............... .. length of each line --10 ........ Total Length'-° Type -laC.- ..Depth Filtbr Material - 'D' Box ..... .. ... T e Filter Material Distance to naorest: Well .....5 .�.._..... Foundation .�..Y........... .. Property.Line T!— SEEPAGE SEEPAGE PIT [ ] Depth Diameter .............. . Number ............................ Rock Filled Yes * x - - Water Table Depth ......................................... ......Rock Size _ .... r rt 14 Distance to nearest: Well .......................................Foundation :........ Prop. Line r ' REPAIR/AD.)ITIONIPrev. Sanitation Permit yf`........................ .................. Data ....................._.. Qe Septic Tank (Specify Requirements) . .................................. .......... . . ..............._......_.................:...._..:.. ._.M -. . Disposal Field (Specify Requirements) .....Jr„?'6.—t ar-). Ar-:5l.GN I.Q..k...........L' ATt1.QW/.i1 DDJr..f� ON 'r-o . Sv�l'f-Em %v7r. .... :X!S'�nlG ° ' O_............... .. ... ;�i• (Draw existing and required addition on reverse a del I hereby certify that I have prepared this application end that the work will be done In accordance with ll n SanJeaquln ,,er, �... •n. 's County Ordinances, State Laws, and Rules and Regulations o/ the San Joaquin Local Health DBMcs Hemewner,ssrs ifuta i} sed agents sirinatun certifies the following: < !' - elt.. "I certify that in the perfa me-ce of the work for which this permit is Issued, 1 shall not employ any periedbfssiekmem. " as to becomr,subject to Workmao's Compensation laws of California." y r '! - Signed . . Owner M< z 7d ^ti...` (If other than owner) ------ .• Title ..... .: rT FOR DEPARTMENT USE ONLY s _x APPLICATION ACCEPTED BY .... .CI. ... . .... 3 ,7 � BUILDING PERMIT ISSUED ,-, ADDITIONAL COMMENT ---, . ...... ........ GATE / DATE Final Inspection .f /!( �........ ... ... .... � /�.......................Date .. .f . �.. .��... :: SAN JOAQUIN LOCAL HEALTH DISTRICT : 1 ` E. H. 9 1-'68 Rev. SM