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APPLICATION FOR SANITATION PERMIT (Complete in Triplicate) This Permit Expires 1 Year From Date Issued SIS:( Permit No. 1 _— Date issued r!.4"..t).721.- . 7 ... t-4t ert-Ec-/A-- k Application is hereby ma e to the San Joaquin Local Health District for a permit to construct and install ihe work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/I. CATIO fie k 't.ii:41- ed-rxe-Z-CENSLIS TRACT . .. Phone City r ,e-7-wg'4l) Motel a Other ... Number of living units:. Number of bedrooms Grinder Lot Size Water Supply: Public System and name Private 0 Character of soil to a depth of 3 feet; Sand 0 Silt 0 Clay Peat 0 _Sandy. Loam Clay Loam 0 Hardpan 0 Adobe 0 Fill Material if yes, type (Plot pion, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) PACKAGE TREATMENT ( l SEPTIC TANK tic sizeiy / 91,2 7 / BP Liquid Depth Capacity 3t 2-e Type-•444•4-4 Material .)Z,nni.. _... No. Compartments Distance to nearest: Well ./Aa../44- Foundation /4"--- Prop. Line ..5.7 LEACHING LINE (t/r. No. of Lines 4 Length of each line 'Agit, Total Length ,a 'D Box Box .7'.-- Type Filter Material XX. Depth Filter Material _ .,/". I' Distance to nearest: Well _./P.e.,/-ti- Foundation ./..P. Property Line SEEPAGE PIT (t< Depth . ,4441-- Diameter r//" Number Rock Filled Yes 121---- No C, Water Table Depth -1- ' 1.1 ' JO. Rock Size 1.7.1- "A/ .::.? 'fr. Distance to nearest: Well /:-Al Foundation — /It Prop. Line REPAIR/ADDITION (Prey. Sanitation Permit # Date ) Septic Tank (Specify Requirements) . Disposal Field (Specify Requirements) (Draw existing and required addition on reverse side) hereby certify that I have prepared this application and that the work will be don. in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any person In such manner as to become sub (Oct to Workman's Compensation lows of California." • Signed Owner By L2iee4-A. Title ie--#41,-rz-214-4-4" (If other than owner) R DEPARTMENT USE ONLY APPLICATiON ACCEPTED BY BUILDING PERMIT ISSUED ADDITIONAL COMMENTS JO. ............. .. 144;1,1;4: . FOR OFFICE USE: Owners Name Acidress 4.?. Ar4 9 Contractor's Name . ..... .... # /21-3,3-- Phone Installation will serve: Residence 0 Apartment House 0 Commercial oiler Court 0 DATE /O 075 DATE Final inspection by: E. H. 13 24 1-'68 Rev. 5M Date 4 SAN JOAQUIN LOCAL HEALTH DISTRICT