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FOR OFFIC SE: nr APPf.# .... .... CATION FORS SANITATION PERMIT ...... ..-........--• • _ l Permit No. . .. - _ a (Complete In Triplicate) Issued �/ ....................'-__....-.........._...v............• i. Doti .- ,. This permit Expires 1 Year from Dote Issued' Application 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 wilt County Ordinance No. 549 and existing Rules and Regulotions: qVc JOB, ADDRESS/LOCA ION . :a - "b1 ! :�.({--..__� ...................... .....CENSUS TRACT . fi P y .......... ...... Owner's Name -- ..........:.................................._.....I..............Phone .q.31_--_�1. _... city ,U Address,:--.-....-- .t�-..N�.. .............................................................................: _.....��:�----.c.._..-•-•----------------._-._.-_.f.......:...------ Contractor's Name Q ;:........License# ................... Phone ._._. ............ will serve: Residence Apart mi�t House 1i yM �:....- 4t1 :2.. ... _..- -� ( t] Com-me_rcia!oTraller Cocirt 0 -.. ti^ Motel Other--.-=--------- -----------------:..,...__ i ,,� =x'` ._ Number of bedrooms / f Numba v, I ng units:--._.--_._ ...._-Garbage Grinder ...✓....._. Lot Size _Q-_ _�. : ..... Water Supply: public System and name ..........�......................_.__:...._......................................_...Private Character of soil to a depth of 3 feet: Sand)] Silt❑ Clay .0 Peat❑ Sandy Loam ❑ Clay Loam 0 Hardpan p Adobe Fill Material ......... l#yea;type............... :.......... i. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION:% -(Nonseptic tank or seepage pit .permitted public sewer is available within 200 feet,) PACKAGE —} TREATMENT [ } SEPTIC TAMC� ] Size.... ...r:.�..�..R'.S..l................. Liquid Depth _Y Capacity l TY0 .00' tft.terial--------:--. -------- No. Compartments Distance,to nearest: Well 1dQ. t ..............Foundation .a�_ _ Prop. Line i.............. , BLEACHING LINE [ ] No. of Lines _ ------- Length of each line-- -� C�. Totai Length- !0...-.2Z. _ a 'D' Box OdAXA. Type Filter Material _____________L04epth Filter Material .............................................. Distantect�o�nea�rest: We ----/(�0.1- - ..... Foundation ...l,7-/............ Property Line .fs-•.............. SEEPAGE PIT { )J Depth. ---- biometer 4vs� t] er _ Rock fined No `Water Table Depth .................~ _Rock Size r ............ Distance to nearest: Well ---Z1_0............................Foundation ...�S.I........ Prop. Line .... .�..-......:: REPAIR/ADDITION(Prev. Sanitation Permit# ............ Date } a Septic Tank (Specify Requirements) -.................... ........................................--- - ---•-----• Disposal Field (Specify Requirements[ ----------------------------------------- -•---•-----•-•---------------------------- -------:....... . :.... ................. { . `y --------------------------------------------- ..--..»........_... .... ---- - ....._._..------........._ ...______--_..--•---_----___......................:..... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work will be done in actordance with Sdn`Joaquin` County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health,District.-Ham* owner or licen- sed agents signature certifies the following: ; "I certify that in the performance of the work for'Which this permit is issued, 1 shalt not employ any person in such manner as to beco subject to rk qn•s'"Compensation laws of California." Y Signed ----- ------ -- --- - - -•------------- Owner .. BY ---------- ----- ..... ..........--- Title --------- ------ -- (If other than owner) . FOR DEPARTMENT USE -ONLY ` APPLICATION ACCEPTED .BY ........ . .. ......... `--...................................................DATE --.-:- BUILDING PERMIT ISSUED ----------------------- � --•--••--••----••--- - -- - -- DATE --------------------------------------------- A DDITIONAL --•------.ADDITIONAL COMMENTS ---------------- _----------------- ............. --------------------- --------------- ------ .--------•---.-.------ . ---------- ----------------------------------- -------------------- --- Inspec#ion by: .. Dated ....��.�'�..- ....... ` EH 13 2h 1-68 v. � - SAN JOA IN �i.00AL NEAIrTii DISTt2lCT $�7)1 3M