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FOR OFFICE USF2 APPLICATION- FOR SANITATION PERMIT ........IL---—-----------....... (Completerin Triplicatel Permit No. 721-.3-8_� 71 3 .1 , This Permit Expires I Year From Date Issued Date Issued - : '2.31 Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is mod* in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LCN:ATION ........CENSIJS TRACT .......................... Owner's Norna -W..P_....._MAZZ1-,.AqA ................Phone'.7/.%5 /.—'3-r� ... Address - City .S* & A . ....O .r_............_. Contractor's Name --Y- -A Phone 4k.&j3.9.P.3.-L Installation will serve: Residence%Apamn*MHGuseoCommordalCfftilerCourt C] Motel 0 Other ................... -------------- ...... Number of living units: Number of bedrooms ..Sr.....Garboge Grinder ............ Lot SUs Water Supply: Public System and name ..............._............ ..... ..... ....................................................Private Character of soil to a depth of 3 feet: Sand 0 Silt E] Clay Fj Peat D Sandy Loom [I Clay Loam%I Hardpan E] Adobe [:] Fill Material . - - If 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 ci�oilable within 200 feet,) PACKAGE TREATMENT ( I SEPTIC TANK [ ] Sire.....____------ ............ Liquid Depth ...................... Capacity ... ..... ... ...... Type Material...... No. Compartments .,-............... Distance to nearest; Well ........ ... Prop. line ............... LEACHING LINE No. of Lines .........._... Length of each line Total Length _......... 'D' Box Type Filter Material Filter Material Distance to nearest: Well ... Foundation Properly Line .............. SEEPAGE PIT Depth .................. Diameter ......_ Numbe� Rock Filled Yes C] No Wafer Tabhk Depth ...................... Size --------------- Distance to nearest. Well .................Foundation ..................... Prop. Urm ...................... ................... REPAIR/ADDITiON(Prev. Sanitation Permit# ............. Date Septic Tank (Specify Requirementsi _......11........ .......................................................................... Disposal Field [Specify Requirements] ................................. .............._.___._....__,_....... ......... .............................. —------- ...................1--------....................... ........................... ............... ," (Draw existing and required addition an reverse side) I hereby certify that I have prepared this application and that the work will be dome in accordance with Son Joaquin County Ordinances, Slot* Laws, and Rules and Regulations of the Son Joaquin Local Health Disirid. Horne owner or lic*n. sod agents signature certifies the following: "I certify that in the performance of the work for which ibis permit 12 Issued, I *hall noi employ arty person In such manner as to beta T".4ject to yv?r on oni!3anon laws of California." Owner ByTitle ......_'................. [If other than owner) AQ'I 0PAitTMENT USE ONLY APPLICATION ACCEPTED BY DATE ._j!V_2.rV'7................ BUILDING PERMIT ISSUED ---- _DATE ............. ADDITIONAL COMMENTS ....... ...... —--—----------------------- .. . ............ .......... ..........___............. ..... ................... ............... . . ......... ........._-———--—-------------*------- ..........- _Da....... ft......................................................___f4ml lospeeftn b" SAN JOAQUIN LOC11. HEAILTH DISTRICT E H. 9 1-'68 Rev. 5M