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KIK UFFICE USE: y� ✓ APPLICATION FOR SANITATION PE t ` (Complete in Triplicate) Permit No. 7 3_./ ' _..... _--... F•• .•-••-•.••............ .......:.........--. This Permit Expires 1 Year From Oat*Issued Date Issued ..tl:: .:.73 A pplication 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. 549 and existing Rules and Regulations: F 108 ADDRESS/LOCAYI -�2'2 Z s F .............. . .:_ ........:..- CENSUS TRACT 5.;................... Dwner's Name r>ddress ........:.... z-2Z .. .._ -._... C.... . . - Phone ._.__...... ..........:..:. :ontractor's Name ... f c. ity : ..: .... -•- .............. nstalla ................ ..license#�F ?'.. Phorie :...........-....:......._. tion will serve: Residence Apartment House 0 Commerclol❑Trailer Court• 0- ; Motel t]Other........:....: lumber of living units:.....!__.._ Number of bedrooms ?' Garbage ' - --- Grinder..__....:.... Lot Size r"Vater Supply: Public System and name ............ haracter Private of soil to a depth of 3 feet: Sand 0' ..ilt --...- -:irla- -- - •---•--. .. - -- .. - -- -- � - ❑- . ❑ Y ❑ Peat❑ Sandy Loam,❑ Cidy Loam ❑ I Hardpdn Adobe❑ FIll Material ......___:._ If'yes, 1 `tYPe...... .... .............. blot plan, showing size of lot, location of..system.in Motion.'to;wells; buildings,.etc..`must :be;.piaced'on reverse side.). JEW INSTALLATION: (No septic tank or seepage pit perrriltted if public sewe 'is available within 200 feet,) FACKAGE TREATMENT . ... . �... . p h ......................... [ ] SEPTIC TANK; ] Size..: Liqui Det i Capacity .................... Type -----.............. Material:_..:... -- .... .... :No. Compartments .. • Distance to nearest: Well � � • • - �• -��•-••�-� F:ACHI.NGLINE ..-: ---- ..-----..._.:..._•..........:..Foundation ..... _..._... . _ Prop. line_._. .......... ( j No. of. Cines Lengtl of:each Eine...._._.. r ............. to Length - .............- 'D' Sox ...........: TYPe Filter Mciterla( :__:_..:- •--:Depth 'Filter Mcterfa) .:-•.................. _ .._. F:_:EPAGE Distance to nearest: Well .. --._----__ Foundation -. - -.PIT ] Property Line [ Depth ............. .. Diameter ..__........__. t�lumber ......_....,.........._....:Rock Filled Yes ... Water Table Depth No JD Fill ---•-•- -- ...:.... .. .:Rock.Size. Distance to•nearest: Well ------- -- Foundation ... -••:. :PAIR/ADDITION.(Prev. -- Prop. Line -- ( v. Sanitation Permit ....;_.....:..:.. ............. _ . "- --• .. .. .. ... Date ,. . . .. •j . Septic Tank (Specify`Requirements) -- - --........... .................... ............-................ -•------..........------ I;Disposal Field (Specify Req(pirements) -• ...................._:...... ....::---:......•............... ..... ................ ( existing and requiied addition on reverse side} hereby certify that I have prepared this application and that the work j will be done` in accordance with Sari Joaquin F�unfy Ordinances; State Laws, and Rules and,Regulations of'the'San Joaquib i.ofol Health DIsidd. Hese owner'or licen- d agents'signature certifies the following: . certify that in the performance of the work far which this permit is Issued, i shall not employ emy person in such manner to become subject to Workimoh's.Compensation laws of California." f ' 'ined ............................... =- - .-- -- ... .......... ...... ----••--- _...-----•-._ Owner �. ••,� ... - . (if other than w ``'�_ . Title = 4ut :: ................. F o nerj FOR DEPARTMENT VSE ONLY r'PLICATION ACCEPTED BY .-'. : ... : f.' IILDING PERMIT ESSUED - .... DATE. ,'- )DITIONAL COMMENTS....._.. • .--- --::.:-.:.: ........ ....... . . .... :DATE ..... ... ......... . ................ .:---------- ---------- - -•---------• ._--------..... ..---- .. ... �. . .... - -- .. ----------------------------- ►al.-I.-n.-.-s.-.-p-.-.d.-.c... nspection b : ... ,�", __. -••- . ................ :SAN .JdA ,_.:_.... -.Date ! :� QUIN LQC/,If HALT�I 415ZR(CT:.