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FOR OFFICE USE: A APPLICATION FOR SA�ITATIQN PERMIT Permit No. ...7.3::-31.3 ......-47-73_...... (Complete in Triplicate) .............. Date Issued ... ............... .. . ------- .�.:-.7�:�-� • _ . _ ........................._....-. . . .-.. This Permit Expires 1 Year Fram Date Issued the work rein Application is hereby made to the San Joaquin Local wi hHealth CounttytOrdinarnce a perNo'.544 and ex sting Rulesit io construct and talnd Regulat orhis: ddescribed. This application is made in compliance ^/J�� , M 4 �. .. ACT � ep ""...... �:y:.-.•:....x.-_ ♦�.. `ter �� � CE PLUS TR JOB ADDRESSAOCATION - - _....��. ................................. .. �. one H.. �. .� Owner's Name -- Address .......14-J-✓- ..._.... -...... City - J � y �.�1�. License Contractor's Name .".. - • ..... ..•----- -••-----• __2'4f' i al ❑Trailer Court j=] Instollotion will serve: Residence [V Apartment House 0 Commerci �� t�✓ Motel ❑Other - .............. ( s Number of living unify..-.. .-.._ Nurriber of bedrooms ----.•.Garbage Grinder --- -------- tot Size`__1 `-......_. --- I �'' ..Priva ....................... to I Vl ------------_--•............... Water Supply: Public System and name ------ .................................. - V. Character of soil too depth of 3 feet: Sand❑ Silt❑ Clay E] Peat 0 r Sandy Loam 0Clay Loam ❑ r�,�� i - ............. Hardpan C] Adobe:V Fill Material ............ If yes,type .............: r„�,... buildings, etc. must be placed on reverse side. ]ti (Plo{iplon, showing size of lot, location of-system in relation to wells, , 1 NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availabSe within 200�feet,] ��)d 1-� ij� yy� (� ...Q.__ -••---. Liquid Depth ... .:_...... pAClG4GE TREATME� ( } SEPTIC TANK' size..---�....�•. --- No. Compartments �- ... Material._• "' Capacity ..� -O.ATYpe .._..... ' � r Foundation ..._. ......... Prop. Line W64. .. x Distance to nearest; ellQ••••-• `LEACHING LINE No. of Lines ... ... Length of each line.-"-..ac ----------- Total Length -- +�• D:...__. - i� .Depth :Filter Material 'D' Box ...- --... Type Filter Material ......... -- p a - � iC -G?.--r... Proper `_bne-,�� • P Distance to nearest. Well --/0-Q••�---•��Foundation ....--- i . ...,. Number_..::_:-.-.-t `�- - ._ FiII d Ye Z No [] Depth Diameter_ :_.... G_ Rock e s 'SEEPAGE PIT [+ p `;r l I --_----^— .....---...Rock Size I Water Table Depth. 1�---- Distance to nearest:�Well ........................Foundation1 ]Prop L ine _ _ ---- 1 ........... i p I ` t .----1• •- •��11-,--- _ -•- •, Date •�-----�. -_-.-.-...-. REPAIR/ADDITION(Prev. Sanitation Permit # . - ---•--••••-----••----- • -.- Septic Tank {Specify Requirements) ............ . .. Disposal Field (Specify Requirements) yr {f� : l q . •-•-•-- ...... ... .......-•---- ......-- ---------------- --------•---•----•• ...... t (Draw existing and required addition on reverse side) 111 .1' application and that the work will be done in accordance wi hereby certify that 1 have th San Joaquin prepared this County Ordinances, State Laws, and Rules,and Regulations of the San Joaquin'Local Health,District. Home owner or licen-, sed agents signature certifies the following:; ^- "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner. as to become subject to Workman's Compensation laws of California." Signed Owner ------------- -- d7--..._. ....- ............ •---- -•- YItie ...... (If other than owner) i1 1 t FOR DEPARTMENT USE ONLY f DATE APPLICATION ACCEPTED BY . . ...............•........ •-----------------••-------•----i........._..._.... DATE BUILDING PERMIT ISSUED :.................... _-... .---_....._ s_ ADDITIONAL COMMENTS ...............................'.....--.......... .-..-•-••--.................. � . d .....................•-- ....._..._..._...... ---- --..._r. - ----_.----•-•--•.-•........ ................."_.-._._-..--.-..-__..-_-.............__-_.. .............."-.. ...........'.. - /!"\_ .....!...._..........._.......Date ...._.....-___-- Final Inspection by: E I SAN- 7/72 AN JOAQUINI,LOCAL,'HEALTH DISTRICT, 7/723 M Y 9 'i. _