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�t FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT /! .... . Permit No. _(C7.'.9..X (Complete In Triplicate) -_.. .. ......... ._.. ...... This Permit Expires 1 Year from Date Issued Date Issued ./..6...X..£'.:49 Application is hereby mode to the Son Joaquin Local Health District for o permit to construct and Install the work heroin described. This application is mode In compliance with County Odincnce No. 549 and existing Rules and Regulations, JOB ADDRESSAOCATION ...R.lt...a4170.N..........11,0✓.a.k . 1. . ... ... _..CENSUS TRA ...5..my1C. Owner's Nome .........2234 . 5......MC ............AQc 4?&J.. ....Phane . ?6 .......s0 .......... Address .. .i l. .e,....5........ le... r.1Ap.........................................City ................................................... Contractor's Nome... ...... # ..... Phone 1... .�'. A _. Installation will serve, Residence❑Apartment House Q Commercial [:jTrailor Court J] Motel (]Other WORKS.HG.Y........R.F.S-I-ROOM ' Number of living units,.......... Number of bedrooms ............Garbage Grinder . __ .. lot Site ...AltzAWA.E.+a .`....... Wafer Supply: Public System and name .............................................................................................................Private !p Charoctor of soil to a depth of 3 feet, Sand JK Silt❑ Clay Q Peat 0 Sandy Loom J] Clay Loam p Hardpan o Adobe ❑ FIII Mnterial .NO..-ff yes,type.............. ... ...... (Plot plan, 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 (Tj SEPTIC TANK[ J Sive.....*..'T.°......... . .......... _ .. . Liquid Depth ....................._. �AI Capacity .P..O.?....... Type ................ ..... No. Compartments Z= Distance to nwresh Well .. .Z.A..R.'.................Foundation .. .._.. ...._..... Prop. Line ..................._. LEACHING LINE bd No. of lines ...._.. ./._. Length of each line S_O Total Length .�..�..............._. 'D' Box ...../.- Type Filter Material "(!A!-Depth Filter Material ...... Distance to neorestt Well ...J� s..11..... Foundation Z . .. .... . .. Properly Line ...................---- SEEPAGE PIT [ J Depth .................... Diamet .. ........ Numbe Rock Filled Yes (] No Q Water Table naptic ............ . .................. ..Rock Size . ..... ... .................. a Distance to nearest.Well .... . .....................Foundat{on .................... Prop. line ................... REPAIR/ADDITIONIPrev. Sanitation Permit♦ ......... ........ . Date ._... ... ...... ................1 Septic Tank (Specify Requirements) ...- . _Y.......... ...... . . ... ....... ... .. .................__... .., ..... _ ................ Disposal Field (Spedfy Regviremenh) ...••e�..... -kA«. �$ ��.... h4ir )1- . .'11Am p',.... ...... .�.1AfADgV&rr— 4M.CN.... `1500..... SNS►- coNgi. TRecNsr .. TR.NK... r n .$O ._ OP. .. . 2i/ IDrow existing and required addition on reverse%idol 1 herby certify, that 1 have prepared this application and that the work will be don* In accordance with San Joaquin County Ordinances, State Lave, and Rules and Regulatierts of the Sen Joaquin Local Headh District. Home owner or Ilcen- sed agents slynature certifies the following: "I certify Met In the p*rformonu of the work for which this permit IS ItWed, I Shall reel employ any person in Such manner as to become sublet, to Workman's Compensation lows of California." Signed .. Owner By 1'Z/ JRIe IIyZAISI Iif of or than ownerl _ TFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY `t-49-99 OATS f 1- 61 , BUILDING PERMIT ISSUED ///''' TATE ADDITIONAL COMMENTS Final Inspec4,Qr_b �� , Duh. SAN JOAQUIN LOCAL IIEALTH DISTetC' F 1. 68 Ree SM