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'MR OFFICE USE: W'F APPLICATION FOR SANITATION PERMIT Permit Na. .�.� .....:.................rryy........................... IComplete in Triplicate) .......:..... P....�. ................ ..;w._.._. Date lssued,r�.:..t.:..... This Permit Expires 1 Year From Date Issued Application is hereby evade to.the San Joaquin Local Health District for a permit to construct and Install the worts herein � described. This application is made In compliance with,County Ordinance No. 5a4 and existing Rules and Regulations: JOB ADDRt:55/LC►CATION,./ '� ... Y.. ...:.......:............................:.CENSUS'TRACY �...................... Owner's Name � ........ ... ................."................ ... .Phone .......................... Address ,� 4�,��. .fC'Fr :'. 4 ................City .� .................................................. .. .. .. .. . - ho'. License � neContractor's Name ........................................ . ..................... . I e Idence eA ortment Huso 0'Cbmmercial(JTrailer Court 0 ; Installation will servo: tp P a , F .� . 4 ❑ . — --•............. Motel Other.--•........................ E . Number of living units:-----....... Number of bedrooms .. 2: Garbage Grinder ......... ...------- Lot We .........-.............. .................... �: .Private V3,Water Supply: Public System and name ------------------ - --- ...._ .... --.._...__.:....._....._.......----•....... Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clays❑ .Peat❑ Sandy loam ❑ Clay'.Loarn 13 [ W V-' N;Hardpan E) Adobe Q ,fill Material ...._.......!f yes,type ............................ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse sldet NEW INSTALLATION: (No septic tank or seepage pit permittedk If public sewer is a4liable within 200 feet,) PACKAGE TREATMENT"'[ SEPTIC TANK I ) Size..`'................................°----_-.... Liquid Depth ............••............ ................... --------------- iCompartments' . Capacity .... Tape---•- •---•-•--•._-MaterlalFoundation ..j�o._.. . Po ................... • Distance to nearest: W .. p• Line ............... ... � . J LEACHING LINE [ No. of Lines Length`of-'ea'ch line----........ .:.:...... Total Length • 'D' Box .........-.. Type Filter Material ...I ..Depth FilterMaterial _�i a�.......:... ....... :..:. k Distance to nearest: Well ......................... Foundation ........................ Property Llne ......... ......... ..... SEEPAGE PIT [ ) Depth Diameter) umber Rack Filled Yes ❑ No (] ........--•---•-- r Water Table Depth ......... .............................Rock Size Distance to nearest: Well -.............Foundation Prop. Lina F REPAIR/ADDITION{Prov. Sanitation Permit ......._ .. Date -1 Septic Tank (Specify Requirements) --........-- ......� . ` ,,: .. `.a`:..... ....... �.....- �--... Disposal Field (Specify Requirements) -- �� •-. . .. •••••• - --- --- - ----.. .....•- -----------------------••-......----•-. ......._..._......................----•--•----....................._....--.... ........... .................._ ............. ......................•- .....-• -•--•-•K••-•------................I........................ �......._........ ..._..........._......_...., . ..... (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 Sass Joaquin 'L County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hoene owner or Iieen. #: 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.such manner as to become subject to Workman's Compensation laws of California." Signed ... �� -� ................................. Owner ............---....................... .... � •----•---•...... Title [If other than owner) FOR DEPAWMENT USE ONLY 77 APPLICATION ACCEPTED BY .4r ...... ..............••.. ........... DATE ... ,,... BUILDING PERMIT ISSUED .. . ........... . ... .. ......-.... ................ DAT - _.f � �"�.-:- lam ADDITIONAL COMMENTSr. :.:........................... .........................I.............................................................._ ..................................................................................................... - .. ..... ...........I................... -.... .- Final inspection by: .....--... Date .. �.r'�' .:....:........... EN 13 24 1-511 Rev. 51 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M