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..... APPLICATION FOR SANITATION PERMIT 7-d-AO (Complete In Triplicate) Permit No. . ..... ....•..»- ........................... This Permit Expires 1 Year From Date Issued Date Issued olll�-/f.727 ! A*i"*10n is hereby made to the Son Joaquin local Health District for a permit to construct and install the work herein described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations, JOd ADDRESS/l=IONgrice CENSUS TRACT .vOwner's NaAddress J AtEta. . ..........GitycaLr L. ' Phone .. ........ConMac►or's Name . .License p /�r3f r•...... . . Phan. .............IntadAation will serve, eAportment House[] Commercial ❑Trailer Court [) Motel❑Other . . ....................... Number of living units, -I Number of bedrooms .w3......Garbage Grinder lot Size 0 5'I-•e!!.� VAWW Supply, Public System and name . ........Private Fill'........................ ....... ..... Chcrocsw of soil to a depth of 3 feet, Sand❑ Silt❑ Cloy ❑ Pool❑ Sandy loam Fg Clay loam ❑ Hardpan❑ Adobe❑ Fill Materlal . . if yes,type . . •.......... IPIa piort, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on revere side.) ItM1INFOWALLAWMI lNo septic tank or seepage pit permitted if public sewer Is avoiluble within 200 feet,) 'f 010 PACKAW TREATMENT ( ) SEPTIC TANK�) Size.f$ ,r if A..S Liquid Depth -q-................. wow Capocity 10tw,�,i,Q T (eJ • YPe ..... Moterlcl.0crnk No. Compartments ,...�............ Distance to near st, Well . ..... ... ......... .Foundation G' Prop. Line.... ,r W LEACHM LINE [� No. of Lines ...,. .rs............ Length of each line 80 Total length ..r'�.Y.� N Type Filter Material ...,. . .~, Depth Filter Material . /.'I',''.,,,, ..»... �. � Distance to nearest, Well ..,,,,.,��t.�........ houndation ' �► /D Property line ...5..........».,.... SEEPAO!PITO Depth Dimmer--.—_. ............... Number . Rock Felled Yes E3 No O Water Table Depth •..............»............................Rock Size IDistance to nearest, Well .................................,,.....Foundation } REPANVADaf JON Ihw. SonNation Permit tM Date Prop. Line ...................... S ! Septic Tank (Specify Requi►emenri) . .. .... ............................ ...•...... ...... I. . . ..............`/00 Disposal Field (Specify Requirements) ................................................. .... A ........ ..................... i .. . _...........I........... ........ ... . .. ........................................................... ... .......................... (Draw existing and required addition on reverse sldo► I hereby certify that I have prepared this application and that the work will be done In accordance with Sam JeeMulm County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin local Health District. Home owner or gcers- sed atoms signature certifies the followings "1 certify that in the performance of the work for which tilde permit Is Issued, i shall not employ any person In such mosmer as to become subject to Werkman's Compensation laws of Califemia.,, Signed Owner litle (if other than owner) - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY :,,. BUILDING PERMIT ISSUED DATE_ .. "�"' •'�•' ' ADDITIONAL COMMENTS....... ....... ..................... ._ ........ DATE Final Inspection by:.. .....�?. ••,_... .. .... ... ................................................ ........................ ....... .- .. ...................................... . ....... ... Date �.� .... .._. SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M � c