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�4 UK OFFICE USE: .... - (_APPU CATION FOR SANITATION (�A ...................................... IT Ocomlefe if, Triplicate) Permit ......... ................ ................... 'd ��+�%fps ............ .... ....................................... This Permit Expires I Year From Data ED sued 0 a t a 4r',e d I er nit 0 Application is hereby made to the Son Joaquin local Health District for a p it :061 ru'Pand described. This application is made in complion 0 o co I r ' and' 71tall" the work herein ce with County Ordinance No. 549 and existing Rules and :Regulations: 'JOB ADDRESS/LOCATiON..,.�.PS-0_0 ...... ::�V 1#4 )?4�' ------ --- jq;% ......... ....................CENSUS TRACT ................. Owner's Name..... ....... D.elviA.4 ......... MY-CZA .......................... r ..................................... Phone S9`Q- JA -0 �.._.__ Address ................. .. ....................... ............... City .................................................Contractor's Name --- ............... ___..License Phone -5--1 J ........... Installation will serve.. Residence [3 Apartment House 0 Commercial []'frailer Court 0 Motel 0 Other Number of living units:..../-•---- Number of bedrooms ..... Garba e Grinder ............ Lot Size ............ Water Supply.. Public System and'name ...................... ..............I........... ---................Private gg Character of soil to a depth of 3 fedit; Sand IN Silt Clay Peat E] Sandy Loam o Clay tou'. mo Hardpan p Adobe 0 Fill M6 . terial _.........If yes, typo ..................... Mot plan, showing size of 'lot, location of system In relation 0 (A amust . tcced to wells, buildings, be . pf -_ 06 reverse r . a]doi it NEW INSTALLATION; Wo septic tank or seepage pit permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT f ] SEPTIC TANK N: $e . ...................... Liquid Depth .......... Capacity ---- Type _<4.f!t?'MaterIaI .... <9'A/C,' No. Compartments ............... t ............. .n Distance to nearest; Well ........ ...I..•---•-----... .. Prop. Line D" J ye, LEACHING LINE No. of Line's ------ -"-k ........ (6ngt'h of each line ....... .47 ............ t, Total Length - - ... I ........................ D' Box ------ Type Filter Material Depth Filter Material ....... �O 0,: V% ........................ Distance to nearest- Well . . ............. .- Foundation J�K . ........ Property tlno:_; SEEPAGE PIT Depth I Diame'ter . ................ . . Wml�ir .... ' I . ............. Rock Filled Yes ❑ No C]p Water'Ta.ble Depth ......................... -----------_ -----.Rack Size ..... ............. I........... Distance to nearest: Well ...... ) ...................... ........... Foundation .................... Prop. Lino ...................... REPAIR/ADDITION (Prev. Sanitation Permit# --------------------------------------------- Date ............ .................. Septic Tank (Specify Requirements) .....................................------- Disposal Field (Specify Requirements) ................................ ...................................................... .................... ..................... ............... ......... I .............................. ................................. .......................... ..................................................... ..................... ............................................... ---------------------------------------------------- : .....................-••--..._......I...................................... (Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be -done in accordance with Son Joaquin County Ordinances, State Laws, and Rules and Regulations of the San J"cluln:Local H*al&D1'strId- Home owner or I Ilcon- " agents signature certifies the following. I I "I certify that in the performance of the work fol which. this -permit is issued, I shall a I at employ any person In such manner as to become subject to Workman's Compenscithin lowt of California.,, Signed ....... Aey.711_-Ze r --- --------- --- --------- ........ BY -------- t z ................ ............... . Title ...................... 01 Y_ ---------- Owner ................. ... . ................... FORMPARTNIEVY USE ONLY APPLICATION ACCEPTED E81 P MIT ISSUED irn as , ............................ ........... DATE / - - -------------------------- BUILDING PERMIT ISSUED ---------------T E ITiONAL COMMENTS..... ---------------- ........................ ............. .............. ................................ .......................... ADD ............ ............. I ---------- ................... I---.....---•-•--•.....-•-•. -- .......... I ................... ................ .......... ...................... ........... I ........ ...................... I I .................. ------ .......... y..... ...................... ---------- %. ................ ............. ....................... ............... - - -------------------- ................ ........................... 0-,.. o; ----- ............... Final -lnspectior;-6y:--.--.--- 4;;:T.w 1--_-------- -------------------------------- ...... .............. Date 070 0 0 •07 4 C ----------- ......... EH 13 24 1-68 V. SAN JOAQUIN LOCAL HEAtTHk;vSkRICT 8/71; 3M