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t FOR OFFICE USE. APPILICATlOh! FOR SANITATION pERJIIl1T -.............. ...... �� `' r.�,p . , ,. #Completeln.Trlpllcatel �. .. Permit No. ... :G . .. This Permit Expires 1 Ysar From'Hato Issstod Date Issued ... I_ Application is hereby made to the San 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: r JOB ADDRES5/LOCATION ..........2709 Munford Ave. •-----•-----------------•------......--••-- CI:NSLIS TRACT Owner's Name ._..Bruzz.one___ax1din Phone --- ..........-•----_....... ...........:................. Address ; 2.9p ...bac• -ice--Ave.......::.............: ..-,city ... ..... Contractor's Name _R o to Rio o t e�r Sewer Ser, License 271.539 Phone 11.65-261.6 ............. ...... . ------------.......... - Installation will serve: Residence❑Apartment House C1 Commercial❑Trailer Court 0 Motel ❑Other 1 --__---•-------------- Number of living units:.... Number of bedrooms ...�_......Garbage Grinder ............ .n... Rot Sine :6al...0..y.200' Water Supply: Public System and name ................................. .... . __..............:....._...-...._...-- ._............._.._.. - .....Private Character of soil to a depth of 3 fee t: - Sand o Silt o Clay .❑ peat[],' eat❑ Sandy Loam o Clay Loam Hardpan❑ . Adobe C Fill Material n9......if yes,type.... ..:.. ....:....... (Plot pian, showing size of lot, location of system In relation to wells; buildings, etc. must be placed an reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted'if-public sewer is available withln 200 feet,) PACKAGE TREATMENT .[ ] SEPTIC TANK I ] Size—........................I.....................:_ Liquid Depth ________-___......_.. .... Capacity ----•............... Type .................... Material........................ .......- Distance,to nearest: Well ....................................Foundation .......................fProp. Line _ LEACHING LINE [ I I fd. of Lines ........................ Length of each line............................ Total Length ype Filter Material _.......Depth Filter Material r i [3,Box T ................. i Distance to nearest: Well -__................... Foundation .......................... Property Line . Number r .... . ._ SEEPAGE PIT [ l Depth i-----=----------••-• Rock Filled Yes ❑. No 03F .t Water Table Depth ---::.....Rock Size Distance to nearest: Well ....Foundation ................. Prop. Line-or'REPAIR/ADDITION(Prev. Sanitationr Permit Date k [ Septic Tank (Specify Requirements). .......................... ......•......-_.:;_.....:.........................--........-..._..........-- Disposal Field (Specify Requirements) insta,11 40 '• new leach, Zine and 1 nww sump ----- ---•...................... .............................. - =-----------....to...e-xisting---s•ep-tli-a -diLa-i-nage ------&t-a-y--25-I....fes©� �r-e-ak.....................:.......................•-••-•----•.7 � --------------------------------------------------------- -----•--------- ........................-........................................................ (Draw existing and required addition on reverse side). - I hereby certify that I have prepared this applicatloni and that the work will be-done-in accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Nonce owner or Ikon- sed agents signature certifies the following: "I certify that in the performance of-the work far'which this permit is issued, Il shalt not employ any person in such manner 1 as to become subject to Workman's Compensation laws of California.,, j Signed -----•--------------••------------- ...£... :.................................... Owner I BY ------------------------------------,._ ............•--- 1.itle ..---- ContraEtor-- { (If other than owner) FOR D90ARTMENT iJS ONLY APPLICATION .ACCEPTED BY - --.---•... ---------------------....,BATE BUILDING PERMIT ISSUED ............. ............_..-_..:.,---------- ....--.-----------I.........._.. ---. •.----..DATE ---...........--•.•-•------•-------....._..:.._. ADDITIONAL COMMENTS __.__._._..-�...:.......... { I --------- -------------------------------------- w - -- - _..-. ... .......................... ----------------. ...... .--..- ------r Final Inspection by: ' -�_._.. -- ate EH 13 21, 1-68 may. i SAN JOAQUIN L CAL 1-I LTH DISTRICT 8/71J 3M