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FCR OFFICE USE: - 1t� APPLICATION FOR SANITATION PERMIT ......... .......... ...................: 7 v, E Permit No. ..7 ......_.......:. �.. �!' :.:........:............ �" �..,lCornpfet®in Trlplicaltel Date Issued ...........................................-............. This Pen"DErxpires t Year From Ontolssuod �- .� Application is hereby mLod6ito the San Joaquin LocoI Health District for a permit'to construNU.and install the work herein described. This application Is made in compliance with County Ordinance No. 549,and.existing Rules and Regufotions: Y! ' . # JOB ADDRESS/LOCATION .. 75� -. .........................e.:� CENSUS TRACT --.. ......,_ Owner's Name � -- - . .....-- .i ---------- I • Address .......................... .....I.................:City . .__..., ..--••--.. ........ ------ Contractor's Name .....------- ..: _•--•--..License # Installation will server Residence[Apartment House C] �Cfinmercial OTraller Court El .` Motel ❑Other.....-•-----= -------'..... -. . .... % #L f U �j i _ Number of living units:..---/..._: Num_ber of bedrooms._.-.__A...Gar clge4Grinder- 'Lot Size _ _ . .............. Water Supply: Public 5ysfenl and name . . _R__.... .Private 0 Character of soi l to a depth of 3 feet: Sand b Silt Q Clay Q Peat i Sandy Loom Q Clay Loam ❑ .� tistef F i Hardpan 0 Adobe Fill MrlaI .._....r....If yes,type.....:......... ............ ! : r P I (Plot plan, showing size of lot, location of system In relation to:Well3-buildings, etch 1m6a,ibe placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit p4mitted if public•sewer-Is,available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK I I Size.. .. -Liquid Depth ....----.--•-=----- . Capacity .• ---•---•-- .-._. Type .................... Material.--- --_----- Flo.Compartments .................. Distance toi nearest: Well -------------�l..�.: L-.1.uFoundation .... ? Prpp. Line ...................... � I J LEACHING LINE [ J No. of`Lines ....... ��- ......_. Lengt of.eachr-line •��=--T. .�ntr Total—length ....-----------_-----.--•. # T e Filter Mateiia J� I. .. .,0;1 s.e.'.��... .. I 'D• Box _..: p ........-Depth-Filter TUlaterial ... _...................................... Distance to!nearest: Well ......... ... ....... Foundation ---.........._.. .... PropertyI Line -----...--•-----....---• SEEPAGE PIT [ } Depth ��.:...�:------�-•_.. Diameter .�-.•-�........ Number .....................:...... Rock 6 illed Yes 0 No (3)r Water Table Depth '...................................-Rock Size ....:........................... N - Distance to nearest: Welt . --•------ ---- ......................Fourtdatian -- ..------------ Prop Line ......................o REPAIR/ADDITION(Prev. Sanitation Permit s'�_.......-•-----•=---------. Date .....:. ` Y,. .........•.......} I I ! ( i2 �.....,. . Septic Tank (Specify Requirements)....: ..................... ........................................ ••..-------•-- ....... Disposal Field (Specify Requirements[I ••••___- . =-----,-.. .. �� -- . ---------------- J --- .. ....... x_ ..x_.«- s ....... --- . ................. „ .� .._ ----- --------- ............ ”{Draw existing and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done.In accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulatio'ns of the San Joaquin Local Hoalth:District. Horne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, t shall not employ any person In such manner as to become subject to Workman'sCompensation laws of California." { G Signed ------------- • . ------•--- ... = i ( Owner 1. - I BY -'--.... --- _ - - --------- -------------- - Title _...... • (if other th owner)-lam» FOR DEPARTAffliNT USE='ON.LY S APPLICATION ACCEPTED — •- BUILDING PERMIT ISSUED --------------- ----------- --------••------_-- ... ........................-----• --_._ .......DATE _------------- ......................... It ADDITIONAL COMMENTS - -----•-------------------------------------------•- ------------------.-------------.....................-._.. - ------------I........................ .- - ......-••---------------- ......................................................... ........... ------------------------- ----- •-•--•----------------- --•---......._. .:. .. --------.......-------•--...------•-- ----............ - _.-. .. / / -------------------Date .�--�. ----`-'-----_ ....__.. f=inal Inspection bY: .---..1/.1/- _. ..-• -- ---- -• •... .. . ........ ...........---....._.....-...__ EH 13 24 1-68 12ev. 5M SAN JOAQUIN L CAL HEALTH DISTRICT 8/74 3M