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FOR OPpiCE G — pppuCAT1aN FO SANITATION PERMIT Permit,Na. -73-..X (CampleteinTriplicate) . . ......_........................................... _ Rote Issued/..L��-?•=y� y This Parrnit Expires t Year from Date Issued ...�._.. ................................ " . Permit to construct and install the work herein gpplieotion is hereby made to the Son Joaquinfiance Local He( aCounY Ord! No: S49 and existing Rules aril Regulations' described. This application is made in comp' CENSUS TRACT --- --- z�, JOB ADDRE5S/L ION ..._-. .._ -._......... — ......_G� rn 12....._._.._.......................:. ... ...._.......................Phone . ..._ owner's Name al c� .. /?ct.....................(�._....._........._. .x�` / d ...._.._...._..:City Address ./•9�"'... ........ ..... . . ))curse _ .................... Phone ................. : roitei Coot ❑ Contractor's Noma--.�.. ......��ul.1. ..'E'...............__:_.._.._. - Apartment HouseQ�gnnterciai QT installation will serve:' Residence Motel QOther ------ ------------------------ ____._ Garbage Grinder ....•....... Lot Size ------------------ ... jNumber of living units:....,.�--- Number of bedrooms --- ...............—.......^._-----c_-_..,.......-:....__...__..Private and name •,_•--•-----••----•--•------ s Clay hoar"ET Water Supply: Public System Peat Q Sandy loam Character of soli to a depth of 3 feet: Sand O silt Q CJOY � Hardpan Q Adobe❑ Fill Motorial ............if ye ,type ' must be placed on reverse side.) �. (plot pion, showing size of lot, location of system in relation to ^'public sewer ave lab) within 200 feet,# e it permitted if p ... ........__. ' NEW INS N' !No septic tank or seepage P P -,•: �u� Depth ._.,,.. 9 SEPTIC TANK{ 3 size--•-------... -- .._...... _. PACKAGE TREATMENT 17 No, Compartments Type ...........__...... M ial..................... Capacity ....:.............. ...Foundatio ... Prop. Urre_._.:.._ .._. Distance to nearest: Well .......ngth..-- .......... 1 •-- ..-..... total Length ......_......_......_._. LEACHING UNE ( ] No. of Lines ----------------------- material --- Length o.. a dt line,—.— 9 ( pe th liter Material ......................_.._..._.._. - N Filter Material ... ...."...._ P D' Boz ........... Type Property line'............. ... .... Distance to nearest: Well .................. .... Fou ion -...._. Rock Filled Yes Q, No ❑ 1Number ........................... SEEPAGE PIT I i Depth ---- Diameter -------_.........• -•size ................................ Water Table Depth / PWP. line _..._._._..__..— ndation Distance to nearest: Well ......._ ._._I . 1 REPAtR/ADDlT10N(Prev. Sanitation Permit # -••. ••••-•-•X;a"" Dote _ ._..._ ._.•................._.........:..............._....--.... J�C� Septic Tank (Specify Requirements)_......... ........ ..... .. . .... ......___ Disposal Field (Specify Requirements) - •--• „_-- -• ` .--LSD....1=f... :c ..... _ .r1Q,S......... ........ : `........_..... ..,.... - ..............................:............................................... . with sun Joaquin -�•-jOraw existing and Wei required addition on reverse $ t I hereby certify that f have prepared this application and that-the work will I dome in DistrdaMe County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health-DistriN.Metre owner or)icon sed agents signature certifies the following: errnit is issued, 1 shall not employ any "I certify that in the performance of the work for wh Parson in such manner{ icts ihi =p - os to become subiect to Wor ads Compensation laws of California." Owner Signed .. .. . --- -- .... ... ......_. ...... ....... ... .. .. .. --- rifle ............ -•.--.....---_.....-......... By (If at an owner) FOR DEPARTMENT USE ONLY 7 :.. ..... ........:..- -------- DATE .. ..Z j.2fn./�..._ .......-:. _. ..- .. -- .........DATE ..."................._.................... APPLICATION ACCEPTED BY .. .....-.-.. -,...._. BUILDING PERMIT ISSUED ..:_ - :._...................._.. ..... ....._.._................ ........ -:.......................... ................................ ADDITIONAL COMMENTS _.............. ..------..........................._.._...._._.._...........,._... _. .:.-.�.............. • :............. D �.. .... .... --------- • ............. ....- ....._......-.... .......................... .. .... ........................................ .......... .. . ...............ctio...........-------------- ................ Final Inspection by: ---------------- �c� EH 13 24 1-6£3 Rev. ---... SAN JOAQUIN. L L HEALTH DISTRICT