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y .. FOR OfF10E USE I APPLICATION FOR SANITATION PERMIT 'yy ��// (Complete In Triplicate) Permit No!k-:-.vr?..:.,1... This Psnnit Expires 1 Year From Date issued Date issued Opplication is hereby mode to the Son Joaquin local Heo. ti District for a permit to construct and install the work hereto `lewibed. This application Is rngde—inoQaplionce with Cot tv O,Jingnce No. 549 and existing Rules and Regulations+ .k JOd ADORESSlt JCATIC,N ...CENSUS TRACT ..... ' er's Nome Is .Lo 00%a n .I j /VINs I �i�re-'.....lr/........ ....... .. Phone ,S !�T..OJ/ wn ....... _,ddross 3r1 �R.� s T•.. -rr r �'.. ... ..L�!�... .. ........City %!'Y.f�. .......................................�..»... Contractor's Norrie Sr r ............license# ....... .... ............... _.. .... .... . ............... ............... Phone ............... nstottwion will serve Residence 11 Apartment House 0 Commercial ❑Trailer Court 0 Motel h Other . . _ ........ Number of living units Number of bedroom* ... .3 ..Garbage Grinder ...... ..... lot Size ........................................ Meier Supply; Public System and name ..... . .... . . ........_ ...... �..._...........................................................PrisroN 0 : therocler of soil to a depth of 3 feet Sand 0 Sib❑ Clay Peat❑ Sandy loom ❑ Clay loan►❑ THardpan p Adobe❑ Fill Material ..... ...... If yes,type....... ....... ............ 67PI0i plan, showing size of 1%,r, location of system In relation to wells, buildings, etc. must be placed on reverse side.) Niles OMALLATION: (t-'o septic tank or seepage pit permitted if public sewer is available within 200 feet,) •ACKAGE TREATMENT ( ] SEPTIC TANK; J Size................................................ liquid Depth ................... ... ...� Copocity . ...... Type ..... ....... ..... Material... .................. No. Comportments .............-- Distant a to nearest: Well ... .............................Foundation...................... Prop. line ..................... EACHiNC LINF- ( 1 No. of lines _ .. length of each line ..... Total length 'D' Dox Type Filter Material Depth Filter Material . . .. . ................................. Distance to nearest: Well Foundation ................. Property line ........................ -AEPAGE PIT O Depth Diameter .......... . Number ..... Rock Filled Yes ❑ No Q Water Table Depth ... .................... .... ...... . ... .... Rock Size ............................... Distance to neorestt Well ..................................... ..Foundations .................... Prop. line .... ....„. 'tLMANVAD0111M lPrev. Sanitation Fermit# ......................... ... ... ..... . Data .................................. ) Sepik Tank (Specify Requirements) ....... . .. ' *"" -*,*-'*'-"*'****"*'/'"'*"***-*"",**"*"*—**'**'*'"*-"*,.... .. .._. DIsP'o»of Fielej (Specify R virements) • . ...'... � PdtG. ............!1/LeQ/.....` tfT� u ... ................. .... . _ .. . .... . _ ...,... .................................................. .............. Lr ' (Drow exit Mng and required addition on reverse side) 411neby certify Mew I have prepared this application and that the work will be done In accordan” with Rea leegmhs C0601V Ordiwewces, State Laws, and Rules and Regulations of the Son Joaquin Local Health District, Howse owner or Ikea• ed etpwrs signature certifios the following: 1 osoft that In the pe4"monce of the work for which this permit Is Issued, I shall not employ any person in such rnetssser '15s tebeeew•e subls:tt to W rknron's Compensation laws o1 California." 11ned � si..ws/ -s��'ti� /�Ii✓ fe Owner other than owner) FON DEPARTMINT USE ONLY _ PPLICATION A.,CEPTED By �.e? `felt :fir-,�, V DATE ,v� - ..G.M .d ..UiLDiNG PERMIT ISSUED s DATE ...... ....... .... . . AODITiONAL COMMENi; i,.v. Ji*.• • (, �� . J �J 7' l ri s �+ i •nspse<•ion by r- !"r` �'"Z/r/.�r�'�t_ Date r 2h 1-6h L. V. r" •,V', 17erJJtrt tOa-nr r , \11H DISTRiCf 8/7h 3M e. �_