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FOR OFFICE,USE r AppuCAnON FOR SANITATION PERMIT S 73-... . ..................... P p Permit No. ..................._ k (Complete in Triplicate) ' Dote Issued .... t 73 . _:...... This Permit Expires 1 Year From Date Issued Vlicotion'-is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herrin Ej scribed:This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: !^B ADDRESS/LOCATION _........5". ..� .G. .....l3..L'vlL'.....CENSUS TRACT mw'v Name :F1'!?�!I�.__...,.! 4'1 .�1.>?C!......�C._.............:................ Phone .. X323 CYT kadr :: . G :�fi. .: ..lti'�. iz �p-y4 1.. .. 1. ...... _............ .............:...:.License.... ..._ Phone _f i�._....._... t '^ntrador's Name_ 1.=-.._�,....f9...... _.1 .`.e✓:. xr tallatinn will carve Residence fj)Apartment Housr❑ Commercial❑Trailer Court j] ; ve Motel❑Other............... '..mbar of living units .__:J..... Number of bedrooms.3_.._...Garbage Grinder ............ lot Size -..•• ....••- �terPublic System and name .. _...._.......... ........._....---•-••-•-•-•••......._....._..... ....._.Private._. P to[.] horoctei of soil to a depth of 3 feet: `5 Sand�f Silt❑ " Clay� Peat El So Loam ❑ Clay Loam❑ I. r Hardpan 1 Adobe ❑ Fill Material .._._.......If yes, type A:plan, showing sizaof lot loco?ion of system in relation to wells, buildings, etc. must be placed on reverse side.) � a � 4EW INSTALLATM (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) SEPTIC TANK Size........................................... .. Liquid Depth ............•••--••_..._. 2KAGE TREATMENT ( ] �] T ... M eriol.................. No. Compartments Capaaty .... ype ......... ....... _. : Distance to nearest: Well _______________________ ___________Found on ............__..._..__ Prop.Line..---•-•-•--. # , \CHING LINE {) No. of•Lines --------------.......... Length of ach line..-- .__....._..---. ..... Total Length ___.._.___..____-___...._: 'D' Box ............. Type Filter Material .................._ epth Filter Material ....._.__......__.....__.._...__.. �. - Distance to nearest: Well ........... .......... Found tion ------------.--• ----- Property Line ........................ f :PAGE PIT. Depth Diamete- ru er ................. Rock Filled Yes ❑ No Q o :, [ ) P ----•--•••.•- Table Deem: - -. ----------_...................Rock Size .- _---_-_--------------- Water ; - Distance to nearest: Well .. -Foundation .................... Prop. Line _.__...____.___-_ ' -_----••----_---•----- - a sAIR/ADDITION(Prev.Sanitation Permit#-------- .. ........................ .....__ Date ...._..._.-_-_---.-.----•--_.__._.j .I Septic Tank (Specify.Requirements) ._--•-••------ ------ � ................................................. ........---•-•- � ')isposal_Field (Specify Requirements) ---1�r�G .._.?�? - � �` 9�?'•• `` Q... . x• (Draw existing and required addition on reverse side) Vby i�r* that I have prepared this application and that the work will be done In accordance with San Joaquin r,e3 unty Ordinances, State laws, and Rules and Regulations of the San Joaquin local Health District.Home owner or lieeo- ;od agents signature certifies the following: o 'I certify;that in the performance of the work for which this permit is issued, I shall not employ any person in such manner M ' to become subject W an's Compensation laws of California. ned ... .1 .. Owrer �• ._.._. .. Title .... . .. --- ----------• -•--------------- ---••---- ly ... •-- (If other than owner) FOR DEPARTMENT USE ONLY _ 4PPLICATION ACCEPTED BY ... 1•!.r1`..U` - - ............................................. ... DATE ...... ....:fL'."� . .......... ' ;i 1ILDING PERMIT ISSUED ---_-----------..............................................._....... DATE %DITIONAL COMMENTS-.. ;.'.. ..._... = ------- -------- ------ -*........-- ......_..........-------•-•-••.._...._..:._ .................... ter.- ... 1..._.... .�.._.....--'......_ .... ... .... _. .-......... ..... i - �,... -•-- . -; ...-.�............................." -- --- _.-iol Inspection b ��1�✓... `...... ... 1_...:...... ........ . . .... ..Date ...... ....... /. -✓� SAN JOAQUIN LOCAL HEALTH DISTRICT