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' FOR OFFICE USE: y -' APPLICATION FOR SANITATION PERMIT ...... .................................. (Complete in Triplicate? Permit No. . ..�-. -.(-5 ................................................._...... This Permit Expires } Year From Date Issued Date issued .5-`.Z. -;. i3 Application is hereby made to the San Joaquin local Health District for a permit to construct d install the work herein described. This application is made in compliance with County Ordinance No. 544 and existin Rules and Regulations: �IpA�a%%."'•E`C�{_r 7�•t Eta JOB ADDRfSSJLOCATION-'.. _�pc.19n1�o CENSUS TRACT (-- 0$�_ E`-f Owner's 'Name V. Phone f :.._ , Address RtrcE .. - City 5 ? D� T ............ .:. CorOdetor's,Narrie --- 1 + _: - ... License'`#, 1` :-33. Phone _ Q 6d 7 InstaIlotion-wilI-serve:- Residence A artment House • .` ... - CI' :p '[]•Commercial QTrailer Court ��-• -�• -�;-. -.. { f Motel IX•-Other ..:�i_ ��. .�'1 . .. i A 9 Number of fwm units ... Nbmbbr--of-bedrooms.'` ..Garbage Gririder„�” Lot'Size.. � _d �!' /J _ i_• Water Supply.: Public System cind name : ;' •. 4 ... Private . .• -• i Character of soil to a depth of 3 feet: +Sand 0--$iIt 0 Clay Peat❑ Sandy Loam fl Clay Loam � I .. ❑ .. ;.,.. Hardpan Adobe Fil! Material - i ❑ �� Cl : .. If yes; type .......... i Plgt!piart -showing size .of.lot, location of. system in relcition to .wails, .buildingng etc must'.be must..be..pl ,,side.] .CL NI W;INSTALLATIQN• p r is available within 200 feet,) ` { ) SEPTIC TANK permitted tf public sewer j { �tank or;seepage pit_ f ACKAGt TREATMENT ' o septic: p 5�ze...,- -- j --- . Liquid :Depth...................., ,. I fi I Capacity Type ' t t u ----- dllla eriai. No. Compartments ( 'Distance to nearest: Well _ f Foundation LEACHING LINE No. of Lines _ [ ] ---�:'i. LeniA of each line.., i.-..... _ ... Total L'engtFi L.. i _. r ine { .D. Box . Type Filter"Mill ......:. De th Filter .. } #� p ter Mbterial ........' i -Distance to-nearest: Well ` I foundation .._- ...... Property SEEPAGE PIT O. .. . ;. ..Depth• ..... ;.�- Diameter" _ � j f N -mb , ' -. Line, .�. , u er, Rock Filled. .Yes [] ... No CO l Water.`fable Dept �- ': t :'� i p -----•. --• RockSize _ . „_.. t Distance to nearest Well - ..:.... ................. t Foundation ion .... .....:... _ Prop Line- r RI:PAIit/ADDITION(Prev. Sanitation Permit ... ,... Date . .. -- ------ .......... i Septic ianlc (Specify, Requiremeritsl ..............••- •-• ' :._. `- - ¢ F i Disposal Field :(Specify:Requirements) �©.. fh!-2s - ,•.�--- '.�`�1 E „• �..�. ... :--.- = .... .; .. (- bw existing and required addition on reverse side) . r.. , -. ,�.....� [ 1 shereby certify that I, have prepared this 'application and that the work will be hone rn acc6rdaince with San Jaaqulir County-Ordinances,'State Laws;'and Rules'and Regulations of the San Joaquin local Health District. Home awnet'or�Eieen- 'r sed agents signature certifies the following: . "1 certify that:in the performance of the work for whicli this permit is issued., 1 shall .not employ any genion in such manner as fo became subject'to Workman's Compensation laws, of California," ; - - Signed --=--_.. . ----•- Owner BY -. - Title .,.:. . ......................... Of of er than owner) FOR'DEPAIIMENT USE ONLY t APPLICATION,ACCEPTED 8Y .--- . ' ... ,. BUILDING'-PERMIT ISSUED ......:...:..... .............................. S :......;...:DATE ---------- ADDITIONAL COMMENTS = . :. ,.. - ........----•............... ._------- -• -- , •---.._.. ---...__ ... _... .. -- ---- --- ....•-----:;....--- ... ..............' Vit - t. .........:.... , Final Inspection by- .... .... -- .............. •-- --------- Date SAN JOAQUIN. LOCAL' HEALTH D&RICT } I3 24 ` E. H. 1-'d8 Rev. 5M __-- _ 7)72 3 M