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FOR OFFICE USEt - - APPLICATION FOR SANITATION PERMIT t ` _...................... ........—.............. •••••- Permit No. (CempiO»In Tdplicatol 8-7T,- This Permit Expires 1 Year,from Data issued Issued�•1 Issued -•"• _ 3 .4 ' tE .r Application Is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work hereto deuvibed. This app;ation Is made In compllance with County Ordinance No. 549 and existing Rules and Regulations, JOB ADDRESSAOCATION ��1....{1.�0 :!! .-.... . errerr.e�..J'."f.�f.K...............CENSUS TRACT ._........... 3 ._• Owner's Name ... ........ ,. !!..'..»:................ .._ .._. ....._................... .......Phone ....._.............. _.�.__ Address .....2 5... ..:7_. ......Gr .........._e ........' Contractor's Name RMb .License � s ,9 phone � } Installation will sero, Apartment Housso Canrerdal�aila Cant t] MOM C` ❑Other..............................____.• � Y Number of living ueiha__..--- Number of bedrooms ...--._-.Garbage Grinder ......-_... Lot Sire ...__._._...__ .��: ..Water Supply, public System and name ._.r.._._....._..___._..__._.-.__�.---_-..�- Private❑ - Charodr of sail to a depth of 3 feet, Sand r3 Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay loam[3 Hard Adobe Flll Mctrlal ............ Iftype..--.—. ' Par,❑ ❑ Yes, __...._. [ .•, ? s 1Plot plan, showing size of lot, location of rystem In relation to wells, buildings, etc must beplacedon reverse side.) : NEW INSTALLATIONt INo septic tank or seepan_e pit permitted If public sewer Is available within 200 f*Oj - PACKAGE TREATMENT ( j SEPTIC TANK{ J Q Sise..............._.._._...................... Liquid Depth _•, �. Capacity /..'C'a. .. '�'ype ..f. 1t terlal..._-...-...._.._. No ComPanmeMs R ` - . Distance to nearest, Well ...__...._............--_._Foundation .._..._-_.._-_Prop. Utte' - ggg LEACHING UNE ( ] No. of Lines .....-_-----_...... Length of each line......................-,-- Total Length •D' Boz ---I .. Type Filter Material . Depth Filter Material ..,,,.-_....._ - - Distance to nearest, Well ......._.._._� _. ation .................._._ Property Line SEEPAGE PIT ( J Depth ..............-.. Diameter ...... Number ............................ Rock Filled -Yes ❑ He Q Water Table Depth ..._..........._......__.___.._-.__Aodc Sire.._.... __.-__.�_ Distance to nearest. Well ....»......_.--.__—_Foundation Prop. Line ,y a ItUAIVADDITION[Prev. :anitailon Permit f ._ ............_._............_... Data ..._._-•.. _) -^'c" Septic Tank (Spedry Requirementsl ........... _. ._..•,._..... -..__.. ;..-. Disposal Field (Specify Requirements, ... . • L.v..�-^c�.�C_ ._.. �._.--_�_--..._._.. r .._..---_...._................--.....................................--........_.._.._.-----••---........._...._....»..._..-._._.__._-_._- .r y..:....------._...._....._.r....—_-_........._...._.....-....___._....._._....._..............._.........»..._...--...... —_.._.—_.._.:� (Draw existing and required addition on reverse side) 1 s I hereby certify that t have prepared this appilcatlon rnd that the work wilt be dam In accordance whit See Jeegsds County Ordimatos, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Hems owner H ReeW :r sed agents signature acnUies the following: "1 certify that in the performance of the work far which this psnnit Is Issued, I shall not employ any Parsee is such manner as to becom ub)ect to Workman's Compensation laws of California." - Signed .:.. :�� Owner , By .............._(/other than ownaA................................................................... Title ....-......................................................... If ......._ - f FOR D fARTMENT USE ONLY •` APPLICATION ACCEPTED BY..... .. . ....._. .. .......--................................................._ DATE .....d o" _,i'-rl..._.::• 1: BUILDING PERMIT ISSUED.............._...... .. ...... .»._............_-................................ ..........DATE........ ......... ._....»._.....».... ADDITIONAL COMMENTS.............. ..................... ._..............................................._..........-................................. »......._.._....... _........................__:...._..».... ...... ..........._--......-......................................... .....................,......_. ..._......_.... t G .. ...._ .Data........,. ..? $ 77...._--•- F;nal Inspection by: _._...._-. ................_ � _ IIi 13 2h 1-68 Aov. _91 SAN AOUIN LOCAL HEALTH DISTRICT - 8/74 311