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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ..._-- We_.f AV..._.._..-• Permit No. .73-.`.�5.-• .......-- /.- .,(Complete in.TIlk _pli�catel _1 . ;- Date issued .'-ter' ..... ................... .4` .k - Year•Fro n Dine issued � This'Permit Ex gyres 1 D'istrict;tfor-,,a permit to construct and install the work herein Application s hereby made to the San Joain�Li?calLHe 1th` application is made in compliance withount Cfrdinice No. 549 and existing Rules and Regulations: described. This app 'odm ' � �: � ° ....................CENSU5 TRACT .......... JOB ADDRESSAOCATION ... . Owner's Name ...... rl{/ ' ' --• Phone :-: E.... City ! - !G�, Address ....... .._...- _ f, .. Phone . . Contractor's Name ....•� ( I ence [-] Apartment House❑ Commercial ❑Trailer Gert Installation will serve: Resid Motel ❑Other ..--•----------------- - ....... Number of Living units:... bof bedroo Number ms ...9r.~...__Garbage Grinder �?�� Lot Size 4 1 t ................Pri K Public System and name .-------•----------------------•-•--'----••----• •-.... .. e Water Supply: Y petit.❑ Sandy Loam [3Clay Loom ❑ Character of soil to a depth of 3 feet:' Sand❑ Silt❑ Ciay ❑ r y If a ---- -- - ------------------ p Hardpan ❑ Adobe jr Fi11 Mater; I .._..---_-•. Yes,type �3 lot ion showing size of,lot, location of system in relation to ella')Duildings, etc. must be placedey n reverse side.��) IP P NEW INSTALLATION: {No septic tank or seepage pit permitted if taueWer's available within 200 y �. -_...__.. Liquid Depth SEPT;C TANK .1��e� ................. Liquid, .. e. . .. PACKAGE TREATMENT [ ] ..�-............. 'E ` Material �� No. Compartments A Capacity/- � YP .. ' .. ---...--.... Prop. Line Distance to nearest: Wel •.--•-•• Foundation 10, .. _... 7 r............ Length of e line- ---: .. Total length •, LEACHING LINE � No. of Lines -.../---- - ,f ,�/ Depth Filter Mater;al � --•------•--••-""-" J 'D' Box/�e---- Type Filter Material Q P f e ,� ........----•--- Property. Line IZZ29 Distance to nearest: Well ...:..._.. _. ............ Foundation .. Diameter >��...... Number ....... ....... Rock Filled Yes, Na SEEPAGE PIT Depth ._L J —.�- Rock Size " Water Table Depth -- '.................�_. Distance to nearest: Well •.••.l•�Q Foundation ... ..��__. Prop. Line -,� ---• .. ... .......6.l Date .... .... Prev. Sanitation Permit# - REPAIRJADDITION,I� , f _................. Septic Tank (Specify Requirements) . .- , :... l ................ ---•---------------------•- Disposal Field (Specify Requirements) ...b.* -= - ...:. - - --•------•-••---•-----------------------•---...__....._ .... ..__..T.. _ ._.:... ._ �. IDrow exi`sfing and required addition on reverse side ----- on and at the work ll be ne in 1 hereby Certify tithat I have prepared this and Rei ulationstof the 5 n Joaquin oaccordance in LocalHealth District. Home'towner or !can- F Counry-•Ordinances; State-Lawsrfand Rules a 9 sed agents signature certifies the following: "I certify that in the erformance of the work:for whish this permit ;s issued, f shall not employ any person in such manner p as to become subject to Workman's Comport,4tion laws of California:' - Owne'.f. Signed •--- �............................. .................................. (if oth an owned r � . FOR DEPARTMENT USE ONLY DATE .�_..}/...............•. I _..... �. ...__ . APPLICATION ACCEPTED BY .... . ....... ... . --------- ------------- , t. DATE - --... ... _... .. .. . ----- BUILDING PERMIT ISSUED ............. ----...... .................................. - ADDITIONAL COMMENTS - -C�r_�---....�-� -..----.................•'-----......__..,�' !/ ............................................... .T...-...----__...... _..._.._...__....._......._.._.._...........r...........__ •----•----••------•........ Date .. .... . ., _ Final Inspection by- ............... SAN JOAQUIN -LOCAL HEALTH DISTRICT 7172 3 M