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FOR. FFICE USE: APPLICATION FOR SANITATION PERMIT 7�Z-yu o . 30 Permit No: .............••-..... �y74 .........- " ' ' (Complete in Triplicate) ..,. Date Issued /S ... This Permit Expires 1. Year from Date issued l the work i, Application is hereby made to the San Joaquin�a to wit�l�County Ordindrnce permit and existing Rulestalnd Regulations:ein described. This application is made in compliance a� CENSUS TRA . JOB ADDRESS/LOCATION � n Phone Owner's Name ._.. ._..... .._...--•......•.................. C. .• dt.. �?.ar._.... City ...._.._ ... , 6. 7.7 - Address - ----••----•-�----....----•• cense .__ _• Phone ....df�....---....P7 � �a._5� .. Contractor's Name ............V .:�'. _.S-Q-v.ff.1-•.----.....----•---....L' # _..._ . Instailatio Yillllse�e• Residence Apartment House,❑ Commercial flTraiier Court j] Motel ❑Other .... ..............................• --•--- 1 Number of living n ts:..._.L.._ Number of bedrooms _.--��Garboge Grinder .__.__.._... Lot Size .. y-•••• --- Private I Water Supply: Public System and name -------------------------------- I ... ................ Clay Loam Silt Clay ❑ Peat❑ Sandy Loam ❑ y t: Sand D ❑ F_ Character of soil to depth of 3 fee Hardp`n L] Adabe � Fill Material __--_......_ if yes,type .-......... •• (Plot plan,1s+howing %ize of lot, location . system in relation to wells, buildings, etc. must be p laced`on reverse side.) NEW INSTACLATIONb. RNo septic tank or seepage pit permitted if public sewer is available within 200 feet,) ... Size------. --- --- Liquid Depth ......................... ...... ......... . SEPTIC TANK,[ ] PACKAGE TREATMENT [ ] „- No. Compartmen#s ijV cam, -*• .A r •. Material Capacity TYPe ----••------•----. •---• - - - {� y ....�--._.....r-- _ .__.._ Prop. Line ...................... vt ` Distance to nearest: Well .................... ' -•Foundation ...__._..__..__. O -' __-- Total Length LEACHING LINE [ ] Na. of Lines i . Length of each linfe-- --: -"y �' F F undation Filter Material ............................................ D' Box .............. Ty pe Filter Materfial ._...._..---•-- !..'Depth E Property Line --- Distance to nearest: Well I Diameter Number ..-----•-- •---- Rock Filled Yes ❑ No ❑ SEEPAGEr PIT [ ) 3 P -----:•-......._...� .._---- Rock Size� --------------------------------p Line ---•------........ -Water Table Dept -•----•--•--••-._........ k p .. { � Foundation Prop.o � -eare'st: Well ••-----...._ •-----•-•-•-••--••-- I Date p RI'PA[R/ADDiTION'lPrev. Sanitation Permit# ................. a :�n� 1 .......--- ---------- - Sepfic Tank {Specify Disposal eld _{.S_.p_e._c...fReq -i.re:'mentsj ------ " - .. ........................ E, ...tea- ._. 0?A_r �.............. ... - 'oq'Araw existing and required addition on reverse side_ -'A }`` 0 _application and that the work will be done in accordance with San Joaquin I 'here y certify that 1 have prepared this,opp coup Ordinances, State laws, and Rules and Regulations of the San Joaquin local Health District. Home owner ai' licen- sed agents signature certifies th9e foiiow,ing: "I certify thatinthe performance jof the work for which this permit Is issued; I shat t employ any person in such manner as to become subject to Workman s Compensation laws of California•" Owner Signed tle _..... t 7 By ........... -,. - i l (If of a than owner) I FOR DEPARTMENT USE NLY ......... DATE .�-�-r i__............I DATE - APPLICATION AC PTSD. BY ....... . ..... ..... _..---._....---....._..............-...... t :,..............x.' BUILDINGPERMIT ISSUED ......:......................' .. _ -• •- .........................-....._....-.•-••_-• ADDITIONAL COMMENTS `' . ....................... = .....................•------------------- r/L- I e ...._ •--- �, Dat .................•----•• . .. .. . .. . . Final Inspection by: _... .:_-- •- -- •• -- . ' AQUIN LOCAL ' HEALTH DISTRICT 7/72 3.M