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FOR OFFICE USE- APPLICATION u APPLICATION FOR SANITATION PERMIT s ........ .I 3 n............................ r IC4errpteteIn Triplicafel Permit No. I :.l�II •• • Dote Issued ..... /:-- a '.. .... . .... . �_,. ,t.• This Permit Expire: 1 Yeaufrom Date Issued t a Applicationvis'liereby made to`the Son lloaquinFLocal Heolth Dis#r:et`for`a permit to construct'and install #h work`herein described This application is made in compliance with County4Ordinance No. 544 and existing Rules cind�ltegulations: eOz I s. _B ADDKESS/ OCATIQN . .. ............ • hlS TRACT, � At--. .._ : Phone Owner's NarriEe Address �.? '._. . City /............... ..... •-•---•----•----•-•. .. � Contractor's Name---_ . .! ?s, . - �x ---•License*i 211. •7... Phone -------- .............. ' installation will serve: I , Residence©Apartment Housed Commercial OTrailer Court 0 I i i i Motel ❑Other ..... ................... U , Numt' r of living nits Number of",bedrooms i' i Garboge Grindet `-:-. ' .. Lot Size '.:.._-_._. __..._.. .. Water Supply:'-Public System and name.,. € :-- --•----••-...._-. , - .Private Character of soil to a depth;of 3 feet. Sand Ej,< Silt I] •Clayf 0 Peat.Q Sandy Loam 0 Clay Loam 0 , sHardpan Adobe Fill-M6terlol ............If yes,type-. .. ..... • t (Piot plane showing size of lot,`location of system.in reldtion'to wells, buildings; etc. must be placed on' reverse si e • 11 i - o NEW INSTALLATION: No septic tank ar seegeYpit perrraitted if ublic sewer is available within 200 feet) k [ , a t �:�.:.CC.S_..........� :....:. Liquid Depth . `.. PACKAGE TREATMENT [ }. SEPTIC TANK l t. ,.. Size. fcapacity,1 qz>_.. T Fpe :.. . Ma#erial. .....�No, Compartments' ----- :...-- Distance.to near t: Well ..1��Q_ ..Foundation .....f 11 Prop. line _ m _. : _ ... LEACHING LINE No. of.tines ` ',� f te$ gth of 0 .- -. 9 t n f ch line_.. ._ Total Len th - ...... .-. 'D' Sox1 i. `type Filter Material ' S!z DepthL Filter Material E Xr-�� Distance taneares#: Well �.� Foundation k !.P_. Property Line 5 .. SEEPAGE f'1T Depth :..., , Diameter t� '...:`_. Number ....... -- :tock Flied Yes [ No 4] :r i t Water'•Tab#'e Depth �- �.�.� � � -• ----_._Raeli Size �fa� x� _ ' - . } t i i i I 11 i € a i I 5 w ,- '_4-Distonce t•o nearest: Well �1�� :..Foundp#ion .--- a Prop Line ..... - EPAlR'/ADDITION(PYev. Sanrtation'Permit# _::.. ..............�.... F -.--� a :',_.. }............. .... ... . 1 RDat Septic Tank (Specify,Requirements;i) .......= r ---• ..... ................................. ; . ' ... _. ., ... . •---- ............ Disposal, Field S eeif Re uirements)....................................... a s k r a s "(Draw existing and required addition on reverse side)" 'hereby:certify that.1.have-prepared-,this application. and-.th of the work.will be.done in :accordance with Sort Joaq County Ordinances; State Laws, and Rules and Regvlations'of the San Jea4vin Local Hoalth:District.Heine owner or Ilcen- sed agents sEgnahere certifies the following I i._-, ., i I I "I certify that in We performance of the work'far which this permit is issued, I.shall not employ any.person in such manner os to become subject to Watkman's or6pensation luwsrof CaRfornia." ! x _ Signed , , f d -- .........I _.: - --- -- B = '! ��y Owner By -� ••�t- $ � _1#f,other.than'ownerl: Aa 't ,I.._.FOR :DEPARTMENT USE.ONLY ._..3 �. APPLICATION. ACCEPTED, BY �_ . _ s� I d I , - y GG --------------,.DATES �..1- -.9- ----•--...., ---- BUILDING'Pi RMIT 155UED __. - -- ----------------- ••----• DATE ------------------:........._..........!_.. '. ADDITIONAL COMMENTS ------------------------------------------------------ ..................................... ............-...................-.....:------- ................... - i -------------------------------- ----------------------- -----------..._...._..._._-...-_-.---....---•--. ----------------------...._......_...-,...---.. _...._..------.... ---- ---. .. ._._.. .--------- final Inspection b ' ............. ....•---••--.- - •-------------- ----------•---•-•---- py: . :._........ -•-•--••-•-... Date ... � ` •.......... EH 13 24 1-68 Rev. 51 OSAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M