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i FOR OFFICE USE: a APPLICATION FOR SANITATION PERMIT S' ��, [Complete in Triplicatel Permit No. ... ......•-----_•. L.......... ------- -.. ....-••- ---- -• - ........ Thia Permit Expires ? Year From Date Issued 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. s JOB ADDRESS/LOCATION ._..------ ..-- ........ CENSUS TRACT ...............:.. :.... Owner's Name ......... Joyce Luther Phone 60 S: Del" ----•.......................................................... Address ---------------------------------- - city St&ak-tor•3............. Contractor's Name ---.......13o_tm._13p_b.ter_---SJar----------------- .License #Z7 .........153-9Phone Ah57261� h y --•••---•-- L _ f Installation will serve.— te -'Re4l sidn f � use fl Commercial ]Traller Court J Motel ❑Other........................................ �.... Number of living units;---2------ Number of bedrooms 2..........Garbage Grindeir-'?49....-' l Lot Size ..... Ox0 S.. .. _�..•..... I Water Supply: Public System and name ............. Calif. 'Water Ser. --- .................................--...._--._.............. ..._...._ ................... Private Q Character of soil to a depth of 3 feet: Sand O 11 Silt o Clay ❑ Peat p Sandy Loam Clay loam Q E - ' Hardpan❑ Adobe l3 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: {No septic{tank or seepage .pit .permitted if public sewer Is available within 200 feet,} t r PACKAGE TREATMENT [ } SEPTIC TANK } v Size.............................. Liquid Depth F .11 Capacity ................ Type .......------------- Material: No. Com .............. partments Distance to nearest: Well, _°-------------=----.....---•_-•_..•Foundation .._..__._....__......_ Prop. Line ...................... LEACHING LINE [ } No. of Lines ________________________ Length.of each line...................... Total Length ........................... I 'D' Box ..- ,r._.. Type Filter Material ......L------------Depth .Filter Material ............. ' =T Pro a lin............... : [ ; Distance to nearest: Well .................._.....Foundation " p rty a SEEPAGE PIT [ } Depth ---------------------,tiameter.................. Number ----------------- ---------- Rock Filled Yes ❑ No �] ' l ; v Water Table Depth"= ' --••----------••----Rock Size ...................... ... ; Distance to nearest: Well ........................................Foundation _........__._:. .... Prop: Line e S REPAIR/ADDITION lPrev. Sanitation Permit# ..................... -- -.•....__....._ Date .......................... -------}-` ; Septic Tank (Specify Requirements)'. 4......---•------••..............................••• - ------ ._._ .._,__...... Disposal', Fied S # e i ements) _____add appx. .53 40' of leach line and 1_� rr dia. iy P yl 5� c� M ;seepage pit' -----•----•- -- i--------------------- ----------------------- ? ...............—........I----------- �(Draw existing and required addition onreverse side) {{ I hereby certify that:1-have. prepared this application and that the work will be done in accordance with San Joaquin 1 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 tiny person in such manner as to become subject to Workman's`Compensation claws of California." Signed -------------- -- ---------..-----••- ` Owner } By Title ----.--Con.trac.tar....._.,' (I r tha owner} _.._.. FOR DEPARTMENT USE ONL ; APPLICATION ACCEPTED BY...... ........... - DATE .. ... .-. -- -.. -� -------- BUILDING PERMIT ISSUED _..------- DATE -........•---•-•-- . . ADDITIONAL COMMENTS -- ..-•--•--.._...----------- . ..--- •-• - . ----------•----------------•------- -...._ ----•------•-----•- •-- '-------•---------------•-- ... -- ---� ---•----•----.._.. ;. ,--J' Final inspection by: ------------... ..................Date --- ----... .__... ._ :::: -::_-::. EH 13 2 1-6$ �'. SAN JOAQUIN LO L HEALTH DISTRICT 8/7b 3M ��k