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k ROR©F1 fCE USE: xI W. APPLICATION FOR SANITATION PERMIT a.............. Permit No.'__13—:� � (Complete in Triplicate) 4 � .. This hermit Expires Year From Date Issued ' Date Issued ..�:.:r_72 Application is hereby, made[to the San Joaquin Local Health District for a permit to construct and install the work herein I described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: all JOB ADDRESS/LOCATION .; -`�-X93.. �.c�� a� CENSUS TRACT AI ............... Owner's Name .... __/ .....__ ..phone !� ..... ss�4r t« r Address �1?6.......�_._...�'4ra�.`•-•---�. _....._ -1_ . . [ city ... _ ........... Name .._ .................�..............-•-•--.-.•.-.-.-.-.•.....•..�..... . . .. ..._.1.....:........License # ---d-?B,34VV._ Phone-��!��_.�a Installation will serve: C�p Residence artment House's Commercial QTraiier Court Motel [❑Other .................................. . Number of•living units:............ Number of bedrooms` / _ Garbage Grj er _�__._ Lot Size ... :y-:::.::----- �'-..:.-...--- ........... Water Supply: Public System and name .__..._._..: U14 Te J � - I 40 ...............•••• --- Private (y� Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay C1 Peat❑ Sandy Loam ff' Clay Loam Hardpan C] Adobe 0 Fill Material ......------ Ifes, type YPe ... --•--_... . I_ (Plot plan, showing size of lot, location of. system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: �� s (No eptic lank or seepage pit permitted if public sewer is available,within 200 feet,) � � PACKAGE TREATMENT / R , [ ] SEPTIC TANK -��. ,'-w?,0..... Liquid Depth .......................... 78 N 1 � ) Size--••-- ---- ..----- Capacity .. ._ _-. 1 Type •._.-_.-_. •. Materia!_- !-�,•.�.. No. Compartments iii / S Distance to nearest: Well ✓Q-Q•.....7` ........Foundation ./0............... Prop. Line .......... S LEACHING LINE [ ] No. 'of Lines :-_:,.7� .............. Length of each line....... SD ` 1 ------ Total Length ............. D. bx .ark Type Filter Material A-). CAt Depth Filter Materia! Distance to nearest: Well/_Ao .............. Foundation P?j_............... Property Line ' SEEPAGE PIT j ) Depth -,�.--..,-.-• Diameter �.-- _ -- ... Number .._,. ................. Rock Filled Yes No.,b Water Table Depth .- ......tip.................Rock Size _t�1.4 T© 'y i il`ie .. I t Distance to nearest: Well .......1?0 Foundation __. i� --------------•••--- Prop. Line ...f?..-----..... •REPAIR/ADDITION(Prev. Sanitation Permit# __ ..r _........_-................................. Date Septic Tank (Specify Re uir�o�ments-` � ---------------- -.�Disposah„Field; .(Specify, Reiuirements a""`� - _.--•-•----•-..... - - I --- ..................... ---•-... ......... . ---••- .._... ---••----••-------...-•-••------•-.•--------------.-.--_-.•_-.-�---•--------- -------------------------------------------- •--------------•- •------- -•-------- ------------- -------- ----- - F ---------•• ---------- ------- (Draw existing andrequired.add.itiononreverseside)- •--------------- ----••--•........................... I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin 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, I shall not employ any person in suds manner as to become subject to Workman's pensation laws of Cai ornia.'* i. Signed ..... .......... Owner j By ...... ... ... . ... �..._ (If other than owner) �2L IIff !' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .111!...__ s -----------------------•-- -- - ; DATE .` 7`3...-•-- ---... BUILDING PERMIT ISSUED .._._.�l'.................... DATE _......._.•--......---_-- ADDITIONAL COMMENTS ...__!ll'.............. ............................... ... ............... n,.. ._......_ ........ ... ---•-•-•.....-•---••---...._.... ... .._.......-•--- --...---- .....I--•......_..........--•• -••--..._....---•-•----...... 2 ...................... x.- ---••---...---•-•--• :�I •- ... Final Inspection by: t -•-••------------ -•--•-----•------ ...__...-----.........•.....Date _." ' . .............__.. ' SAN JOAQUIN LOCAL HEALTH DISTRICT E...H 13-2-4 • ..,....a , ...- _._.. ._..... ..- _-..:. . .., /�� u Ay