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OFFICE USE APPLICATION FOR SANITATION ................... . .. . _. (Complete in Triplicate) ermN No.�(�:. 1�6. .. �} ( j'� Date issued ...:............. _.L.ri..1../....._.__...._ This PwemitExpires I Year from Dahtssaod Application 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 Ordin Na51..9 and existing Mules and Rogulotionss JOB ADDRfSS/LOC TIC�V ..:.. _.SS?..... _ .. .��,�p 5...... CDCENSUS T/Pef ...... Owner's Name .. Phone �(/1. C-&- I&.................................. .. .............. � . . ... ...... Address : ___-C .4+ ..-... ...Ale&-s..._._.... ..................City ._. o--Affiq,?t�--....._...._•............-.-.......-..._....... &,;s ........................ Plan" .fes t 3s z- Contractor's Name � ..........-•---...License 91E Installation will serve: ftl1kawiff Apartment House 0 Commercial[]Trailer Court C-1 Motel Q Other............................................ /�^ Number of living units:-_.7-_. Number of bedrooms ../Garbage Grinder ............ Lot Size ..� ,X.. '�o.............. Water Supply: Public System and name4.[ .............. ._..-......_......................-........ .......Private Q Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay ❑ Peat[,j Sandy Loam 0 Clay Loam ❑ Hardpan 0 Adobe IN Fill Material ............ if yes,type............... .•-......... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) 6- NEW NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,( PACKAGE TREATMENT j ] SEPTIC TAMC{ ] ogle Size......... ............. ....-............. Liquid Depth .......................... Capacity -------------------- Tyle --------•-••--•----- Material....................... No. Compartments ...................... Distance to nearest: Well ....................................Foundation ...................... Prop.Line ...................... . LEACHING LINE ( j No. of Lines ..............•.--..---. Length of each line............................. Total Length ............................ 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................ Distance to nearest; Well ........................ Foundation ........................ Property Line ........................ SEEPAGE PIT E 1 Depth -••______ .......... Diameter ................ Number ...._....... ............... Rock Filled Yes ❑ No C3 WaterTable Depth .....••--._...•••................•...._...:.....Rock Size ................................ Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... REPAIR/ADDITION(Prev. Sanitation Permit# ..... /.._/. / .._._ .......... ..............•} / Septic Tank (Specify Requirement s) dal.r?t,Q �.........,.-- ...._�c ......... ....... u DISPOSPI Field (Specify Requirements) l . �... .- ....... .....fOl/--------------•--•--....---......-..--•-•-------•-----...__.._•....__.......-•----.........._.._.......................--•---. ........................ ........... --•-----•---------•--------•-•-•--------------•--------•---••---.__.._._....-•--............__....-----•...._.........•---...._....._....._..._..._............... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that the work wilt be done In accordance with Son Uaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hoaltls.District. Henle owner or licew sed agents signature certifies the following: "I certify that In the performance of the work for which this peradt is issued, I shall not employ any person In such manner as to become subject to Workman's Compensation laws of California." Signed ----------...•------- . - ---- - - ............................... Owner By ... .......................... Title ' s ....__ . (If other than owne jek., .FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY = BUILDING PERMIT ISSUED .. - - 6 -'-. .._/ ...... ......................... . . ........ .........................DATE . ....------------------.........---•--- ADDITIONAL—COMMENTS�COMMENTS ...................... ...............•: = :.............. .._...-- ----_._..._...--.- .... ....-----......................................... ----------- ....I . - ------ ........................................................ ............ . -_.. ........ . ...... .................................. .. --- - . FinalInspection by •-- . _.:_... .._ ..... .... ............................................-.._._ ........ .Date EH 13 .2!► 1-6t3 r - ^� - �� _.�._��,. ..•----- AQiJIN LOCAL HEALTH DISTRICT 8/?b 3M