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7 .............foR OFFICE use: ' *._ APPLICATION FOR SANITATION PERMIT IC errple n Trl ee� e1 o tel pfi t Permit No This Permit Expires t Year From Date Issued ate issued .7�.�.7s. 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 Ordinance No. 549 and existing Rules and Regulations: / � G JOB ADDRESS/LOC ......................CE SUS TRACT�.:.2 1�...... Owner's Namef c? Cr.?�.: es:4l?.Phone�c�,,.�e,y,�ty. .. , • Address . : �`. .. ati "- -:•: :City ............................................................................ Contractor's Name - -. ....................License # .P��.l'v`�.��. Phone Installation will serve: Residencepartment House❑ Commercial pTrailer Court ❑ i Motel ❑Other............................................ Number of living units: ------- Number of bedrooms ------------Garbage Grinder ............ Lot Size ........................................... Water Supply: Public System and name-------------------- ............................... ................ Private ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Gay ❑ Peat❑ Sandy Loam ❑ Clay Loam [3 Hardpan Q Adobe 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.)� NEW INSTALLATION: JNo septic tank or seepage pit permitted if public sewer Is available within 200 feet,) I) PACKAGE TREATMENT 1' ] SEPTIC TANK[ ] size------/i B�-. ,......_.._. .Liquid Depth .......................... Ti__,..R�_ p Capacity _ :._._--- yp Material:.__"_'_:'______..:. No. Com artments Distance to nearest: Well ....................................Foundation ...................... Prop.Line ...................... LEACHING LINE No. of tines ' ._ Total length '......i�.................. [ } .._.__...1-•-•.--.--- Length of each line-------��.. p 'D' Box ....4_1 Type Filter'Materia("......... ..........Depth .Filter Material .....--•---- ................................ Distance to nearest: Well -._.9. .0.�Foundation -....M.. ............. Property Line .................,...... SEEPAGE PIT ( } Depth .................... .Diameter .___.._..__._._. Number :...._........__.....__...._.. Rock Filled Yes J�2- No 0 Water Table-Depth -_:.-- :Rock Siie /- ................. Distance to nearest:.Well .:......................................foundation .................... Prop. Line ............... REPAIR/ADDITION{Prey. Sanitation Permit# .........._. ............................ Date ................................_1 i Septic Tank (Specify Requirements) ._-------; •---------- _ -•-------=------•---- - _....:-. ._........., ................ I � .. . DisposalField JSpecify Requirements) ------------------------------------------------------------------------------------- ------------------------------------ •... 4 • -` . (Draw existing and required addition on reverse side) I hereby certify that I have,prepared this appllcatlon and that the work will be done in accordance with San Joaquin County Ordinances, State Lavers, and Rules and Regulations of the San Joaquin Local Health,District. Hoene owner or licen. t 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 y �- ,------- ----------------------------------- Owner 4f BY .-�. -w ---- title --------------- -------- -- ................ .................... other tho1 .;rte . DEPARTMENT USE. QNLY .-�,, . i APPLICATION ACCEPTED BY -- -- -�... `.. - --� F --r'------- - -- _ ------- BUILDING PERMIT DATE ..°,. ../..:7,�_--------------...--- .BUILDING PERMIT ISSUED'.-------- :-.-• -•-. ---- ------------- ��T -= ............ .......DATE ......... ------ ........... ------ ADDITIONAL COMMENTS/a?--, 4/' ,,��_ u�lf.utev . ------cY '_, x.04.-_� . ".._ .......... 3-3_-`.-`-_A':d.1._`_�_/ ------- -------------------- •------•-•---------- ---......_........---....._.._.....--•-- . -----..-....._ ------------------ -- ................................................................................................................ . ----------------- ----Inspection by: -• -- - Date .y- ............. ------------------------- / F EH 13 21 1-613 fiev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M j # A/