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� � r "M.,.lmf, S��4 4wF"^�riT� ^�' �'iyRe.L��.�+Y"MTS�...A'�(�'�EMiN4X.NY?ry %M.'✓[�[r uw.w FOR OFFICE USE _ e. s APPLICATION FOR SANITATION PERM.fT (Complete In Triplicate) 'sa t : r' - This Permit Expires I Year From Date Issued .n Appllcar on is hereby mode to the Son Joaquin Local Health District for a.permit to contiruct and in described This app(cat on is made in compliance with County Ordinance No 549 and existing ktj 8.o411 tirj111 JOB 4DDRESS OCATIO7V Oh/ jGC CENSi15 TRACT iy q '"' { iL rc� Owner's gamePhone .: al r� r�G Address . . . hv'"4?✓.7l 0,. ...... ..City /r nk'r ' ...: :. %= Contractors Name , r .......License tF Phar» � .IFr�C..' ::. Instollahor wR serve: Residence XApartment House C] Commercial ❑Trallar Court 0 Motel 0 Other .... . .. Number c, frying cntts:,.!',__. Number of bedrooms ::........Garbage Grinder A/V .. Lot Size rWater Suaplyt Public Sytitem and name ..... .......... ............ ................................................ . .... .. . .....PrLyciit a Character of soil to a depth of 3 feet: Sand o Slit❑ Clay 0 Peat[3 Sandy Loom [j Clay Loom [3'„ ' Hordpon jo Adobe ❑ Fill Material ..... .....If yes,.type. ....:.. ...... ... _ t (Plot�pl6n showing sire of lot, locationof systern in relation to wellc,�buildings, etc, must be placed on reverie side) ` ,, a NEW INST�ILA'TIONz No sopt'c tank or, seepage pit permitted if public sewer is available within 200 feet) PACKAGEITREATMENT l ] SEPTIC TANK J Size........ ...... ....... .:,... lir(uid Depth ..... =. Capacity Type .. ... Material Na 'ompartmaMs ,:. , > Distance to nearest Well 'Foundation ... Prop Unit AC14,NG LINE t ) No. of Lines .... . .. .. Length of each line .. ... . . Total Length 'D' Box . ..: . .: Type filter Material . ......... .. .... Depth Filter Material ....... ...; Distance to nearest, Well .......: ...........Foundation ............. Property Line ...:... " SEE?AGE FIT r ; Depth .. L p .......:. Diameter Number .. ... .. .... ... Rock Filled Yes a No Q' Water Table Depth : ........ ......... .... ... . Rock Size ... . ... . . ' P/ADDITION(Prev. Distance l. Sanitation Permit 0 ..... ......................................... Fatendation _ . Prop. Line - R PAI x ti< c.nk ISpec fy Requirements) ........ /J J' ., sssol. Field (Specify Re4 cel rements) 0-zlL��F'l /4:'. .��_�•L�l�. //7G .�?.II cT / .-?�K �.1� �^ Y5 (Draw existing and required addition on reverse side) I hereby certify that I have prepared this appliea•ton and that the work will be done In accordance with Son Joaquin °'' County Ordinances, State Lows, and Rules and Regulations of the Son Joaquin Local Health District. Horne owner or Ccori-- sod agents signature certifies the following: -� "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person in such marinec as to become subject to Workman's Compensation laws of California.- Signed alifornia."S gned _ ......_ J .. ......... ... Owner By i .''e, f:u/<7 ' ... Titiv _..L.�7.l�G(d✓11.-:(/�i..:_ other than owner) . FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..........� �. ......C.tr�.��.1.. . ... .. . .. . . ................ ... ... DATE ...f.,/ 7 ''. ... . . ... BUILDINGPERMIT ISSUED .. ............ ........ ......................I................... . ........ ........ .. . .DATE . _. ........... . . . .. ADDITIONAL COMMENTS :........ :........... L`0 .. :. .. ........................I................ ... ... ....... .... . . .: .... . .. . .......... . ... .............................. Data Final !r spection by: :... ............. 1. . .. ....L.�!.71,. ............... . .....,........,.............................. �. ,�.,�„ . .N SAN JOAQUIN LOCAL HEALTH DISTRICT E. h.13 24 1•'68 Rev. 5M - s, 7/723 H dcm �u o- >ti�f�'s+as