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OFFICE USE: APPLICATION FOR SANITATION PERMIT FOR OFFI Permit No. ..7-3..wJ.4 -'...................................... (Complete in Triplicate) : ................. i Date Issued .1..!.l .73 : This Permit Expires 1 Year Fram Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544 and existing Rules and Regulations: / l! .CENSUS TRACE JOB ADDRESS/LOC N ....(D __! -T.: _... .,.., ..... Owner's Name ......_. w •. M_Phone'- .. ... .... -- r�_ Address . r .... _ _ City. , Contractor's Name .:.._.. - "J _ �`- -�"— =--::License# . icPi"Phone" :--:':. ..: -:. ..-:.:.. 01 installation will serve: Residence [Apartment House❑ Commercial❑Trailer Court; :.- Motel.0.Other .... t.. < ... _... ,.. M Number of living units:_....1..__._ Number of.bedroams..._, age e : Garb Grinder Lot Size -_----------- Water Supply: Public System and name -------------------- s__ .. Private [� , Character of soil to a depth of 3 feet: Sand n.:� Silt❑ Cla ❑ Peat Sandy Loam;❑ Clay Loam ❑ d ❑:,r Adobe ..Fill Material 1 1f yes,_type Hardpan � (Plot plan,.showing size of lot,_loeation..of system in..relation to:.wells buildings,.etc.,.must.. be..pigced...on,.;reverse :.side. NEW INSTALLATION: ( P" g- P p.. p is seweris available within 200 feet,) No septic tank or see a e it ermltted if ubl_ F Size. .._ 1'�Q.�__ .:_ : Liquid Depth f . PACKAGE TREATMENT [ ] SEPTIC TANK it L .. ••.....I....... " / .. .., Capacity � ..:_..: Type:- Material::_----- --••- _ 'Na ' Compartments . II tinet ......---.>.._. F f rp = Foundation r. Prop. Distance to nearest: Well ................. ..• tL . ._ No. of lines Length of ;each line.____:.. ....... Total Length ..� 7v ......... W LEACHING LINE { J -- 2 aterial .=.._.. :` :•-.Depfh'Filter Mdtefldl' _../�L:�. {;• V. Box.....; :.. Typis`FltW`M _ .. t _ .. ... Distance to ned�sti-W611a: _ `.•.... Foundation .. :!° :� --• _ -... arty °tirse Founda �'Prop -... .:. t SEEPAGE PIT -[Y1 Depth .: fir----- Diameter ._.. :. Number ...Z. _:..,.'��..��..aRock Filled-3 Yes No [] Water Table Depth? r.. _ .. ti .Rock Size l,( ��F� i - ._ Distance to°nearest: Weil ..._ _._._ ..Foundation Q Prop. Line REPAIR/ADDITION(Prev. Sanitation:Permit# ... ---- Date .. 'Septic Tank (Specify Requirements) --- = -'----. -=• ............... :Disposal Field (Specify Requirements) t R - ......................... „ 17 ---------- ........... ..............................._.... ...._ . ... _. _ .............- -- - � (Drdw existing and required addition on reverse side),:p. ,. t I hereby certify that i have prepared this application and that`the:work will be done In accordance with San JoagaTn County Ordina'ricei,' State taws; dii RuTes-gnd'Regulations of the San Joaquin local Healik pisttitt. Homo"owrtar`or licen- sed agents signature certifies the.following--J. •. '.- ... ,....,,r.. .. "I certify that in the performance of the:work for which this permit is issued, l shall not employ any person in such manner' as to become subject lo.Workman'i,Compe6iatlon'laws of California." ' Signed , 'Own _G ' f3 ,_ ; Y ........... . ...... .......... .. ......... c Sitle v {I'f other t an owner} ;. ... ,. FOR DEPARTMENT USE ONLY i . ...__... i _3__....� APPLICATION ACCEPTED BUILDING PERMIT .ISSUED ..---... .. ... _...' .'; .. - --• s DATE• �-;•• ADDITIONAL COMMENTSL..- y/� =' = ! • ` ,• ` _•_ t •'.' :.::::::;a;� ...:r...:"., ._....---•-- Final inspection by: .rr ° wry/ ' .. .. _` .Date ` y„ .' ......I b!ti!7..t r 6 3 �aSAN JOAQUIN't t 'HEALTH' DISTRICT, _._a_... _ L._ _7/723'M _