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_ �• -- -- ar � FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT 73--33 (Complete in Triplicate) Permit No. ...................... ,• - ----.`�- ........... This Permit Expires I Year From.Date Issued Date Issued Application is hereby made to the Sari J;odquin L�bcol Hedlt h for_a permit to construct and install the work herein described. This application is made in 'tompliance-with County ordinance No. 549 and existing Rules and Regulations: JOB,ADDRESS/LOCATION ` f Addr ...............CENSUS TRACT Ownec's.'Nanee.•. • --.... /... •--•-• .......Ph n ess ...... City �, .. --• -- '+ ...... Contractor's Name . - --- ce ;�//xp. - - - ------.Li use # v�,�/.,.�:�1�...�PFione installation will serve: Re sidence; Ap 'rtment House❑ Commercial Trailer Court Q Motel ❑.Other F.. . . Number of living units.../_'- Number of bedrooms _. __ Garbage 'Grinder Lot Size 1 . Water Supply, Public System and name �,-�_ ; •"-' P rk :, 'vate'0' ,E Character of soil to a depth of 3 feet: ; Sand [] ;Silt[] Clay Clay[] Peat El ;Sandy Loam ❑ "Clay Loam 07.{ _- Hard anAdobe jh Fill Material If yes,type ........::..........:.. . _ P (Mot plan, showing size of EEot, location ofsystem in 1.re d ion fo wells,-buildings, e#c—mus-kie-�pl-oced on reverse: side.) NE'W INSTALLATION: (No septic tank or seepage'pit'permittdd If public sewer is available within 2'60 feet,) s PACKAGE TREATMENT [ ] £ SEPTIC TANK i ] .Size .............. Liquid Depth .......................... , 1 f Capacity .. jV .................... Type --...............,.. Material_-.------- _._.,_-- . No Cam artments ��1 ._ Dista „ Distance to nearest: Well ........................... -------Foundation .............•......._ Prop. Line ....:.. �._.: _D' # LEACHING LIN �[ ] No."of Lines ........................ Length of each lineTotal length ...: ----- Box ...... Type Filter Material ._.Depth-Filter Materi4.al : -- .._.- ;Zr 4.: 1. Distance to nearest: Well .:................:..... Foundation ______---.-___-:---_-- Propeo Line ....._...... ._.... (t} SEEPAGE PIT [ j Depth. Diameterx 7 Number ...............•.._ ...... Rock Filled Yes No [] Water Table Depth Rock Size `#sl .......... ....................... ouDistance to neareN ...:... " 10n )Pop: line ..........--........ . REPAIR/ADDITION{Prev. Sanitation Permit # - .:... Date - -•.-- r - , ..-.- .. ._. .......: ......- ...........„.Septic Tank (Specify Requirem cify Requrem `f.._ ._-Diposal Field {Spe .. . . s - ------- : (Draw existing=and rt required addition oreverse side) ;' I:hereby certify that I have prepared this.application anif that the work will be done-in accordance with San Joaquin County Ordinances, State Laws, and Rules-and Regulations of the Sari�ociquin tical_.Health District:iiorne owner or licen- sed agents signature certifies the following: - -11-1 "I certify that in the perl`ormonce�W the work for which this permit is issued, I shali not empioysany person in such manner as to become subject to WorkmanJ Compensation laws of California.” Signed ------------------ ' ----•--_. - Owner By ........................... . an�I ;,_ le {If Tit • ..... t owner r FOR DEPARTMENT USE ONLY + APPLICATION ACCEPTED 6Y ___: --•-------------- ----- ,� y .: DATEBUILDING PERMIT ISSUED _... ............. .DATE;ADDITIONAL COMMENTS :.._z ` .. . � . .4 •� ,.� ��. ................ ............ ..................:.. •..........---------- ................. .. . ....................... ...----- ................ = ..... ..... -•-;------,--............ .......•---....--•- ...... --- ............ •.`-----.... f . Final Inspection by: . . ' '• ��- � I � ---•---..... ---• --- - ....... ..-----k ...._. .................. ...........Date SAN JO�AQl7li4- LOCAL' WEALTH DI - STRICT - E.. M.1.3 241-'68-Rev_..$M.