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FOR OFFICE USE: -- p_ APPLICATION FOR SANITATION PERMIT ��. Permit No: .-- ------------------ - _ �� ;{Complete in Triplicate) - ----• Date Issued --- is Permit Expires 1 Year From Date Issued 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. • JOB ADDRESS/LOCATION ... _ q J� { Owner's Name c�I '------ t--------------CENSUS TRACT --5- -�----- I- ------------------------------------------- ------.Phone --------------------- -------------- ©� aiy . - --------- Address -------- Q ------ ---Q - / ' - =4- __ FQ1'LC- f License - - ---------- P orie ------------------------------ Contractor's Name --- -------- ------ - - = • - Redrtmbnt oe,[ Commercil: TrailC]Installation will serve: � `Motel ❑Other ---- A ------------------------ NR_ z Number;of il,ivi,ngu , .n its:__ _--_--- Number of bedrooms --- Grind�y-)=,S:Lotrsize, Y _.._ _ ----------n.:.xx.,------ Water Supply: Public System and name --------- ---------------------------- ----�'-- ----------------`--------------------------------- -----Private t ; Character of,soil to a depth of 3 feet..- Sand'Q-�Silt❑ I Clay,[]`{`;Peat E] Sandy Loam C7 �_CIay.Loam -r Hardpan ❑ Adobe',U�' fil[ Material �.__ if yes, type,. ------------------------ t ------ ----------- IPiofi plan, showing size of lot, location of sy em 'n elation to wells, buildings,'.e cc. must be placed on reverse side.) seep a pit'permitted if public sewer is available within 200 feet,) f NEW INSTALLATION: {No septic tank or�0.•. , PACKAGE TREATMENT SEPTIC TANfC - j ., _:S,ze---/ r� %" J-X la 15 Liquid Depth -.-. --------------_ - - -- ------ - �V; , Capacity - ------- Type � .S�TMateniai_ CR Io Compartments ---------------------- If �-- ------ i Distanceto Weare t: Well ---- �----------------------Foundation .-- -----------____-- Prdp. Line ------------•-•------- A LEACHING LINE No. of Li nes ---- ------------------- Length of eadi Line------ - ----------- Total Length ,. 7 _..----.---- _. p' Box �,_I�S- Type Filter Material -4- CA----Depth Filter;Material=-- 9___.- ' --------••---r---•- I Distance to nearest: Well ---/09-------- --='Fou nddfion --`--I----- ---------- Property Line ............ '- SEEPAGE PIT [ Depthrj- ------------ Diameter Number- --„_:___-----� .-- Rock Filled Yes No Water Tab.le Depth ---{------------------------- f----------= _Rock Size..-,-A: -------------------- Distant b „ Distance to nearest: Well '----_------------Foundation -------------------- Prop. Eine --- ...-----.......__ i - REPAlR/ADDITION(Prev. Sanitation Permit _.-i I Date ---------'-----------------------} ; Septic Tank (Specify Requirements) ----------- L r --t -----_.. ------- ----------------------••--- t ----------- Disposal Field {Specify RequirRments) ----------------------------------- ---------------------------------- -------------------------- ----_ ----- --- -'--- -----------------1-----------------------`--------------------- ------ . ., _ (Draw existing and required ciddition 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 Regulations of thelSan Joaquin Local Health District. Home owner or licen- sed agents signature e'rtifies the-follow_,ing: "I certify that ' the erformance of the ork for which this permit is issued, I shall riot employ_any person in such manner as to beam subj ct to Workma pen cfion laws-of California.” Signed�.-- l -------------------- Owner BY ------------ --------------------------------------------------------------------------- .� ------- Title - ----------------- ------------------ - ------------------------- (If other than owner) ' t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . s - ----------------- DATE - BUILDINGPERMIT ISSUED ---------- ------------------ --------- -----------DATE ----------------------------------------- ---------- •. ADDITIONAL COMMENTS ----------- -- ---------------- -- ------------------------------ .. �_ - .� - ----------- -- --------------------- ----------------- - } t, 4 - ti= ---�'- --------- _ ---------------------------------------- ----- ------------------- _ �� _ ---- - _ Date Final Inspee _-. M } -- - ------- -------------------------------------------- a E Y SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. SM.