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OFFICE. - FOR OFFICE USE: FOR O APPLICATION FOR SANITATION PERMIT ----------------------------- Permit No. -7 --- ---- --- (Complete in Triplicate] ----------------- _ Date_Issued�_. 'r6-77 ------------ / `This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joac(uin Local Health' District foia p rmit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: t �..._7 ` �d -- �------ ---/-.-.yTRACT- -----.CENSUS .-----��--------------= JOB_ ADDRESS/LOC TION-- A/-- ---- ------- ---- hone Owner's Name--- - - P r � Cityv -----------------Zip----- -- ----------- -- Address------------- ------------- . License -------- ------ Contractorane 's Name = �' .: ' - : ..- L. e # Ph rMotel ❑ Other--------------- ❑ Trailer Court ❑ Installation will sere ; Resident Apartment House. Commercial ] ` Number of living units. -__/__�_--�Number_of-,bedrooms---S-=Gorbdge Grinder----__. -;_Lot Size- --- -�`-�-`--' J--- -- --Private %�4 Water Supply: Public System and name-- -------------- 1. -.-: ---. , € la Loam y Character of soil to a depth of 3 feet: Sand ❑ SlIt❑ Clay ❑ Peat ❑ Sandy Loam ❑ i Clay Hardpan Adobea lFilkMateraal- ---If yes, type-------------------------------- t l (Plot plan, sNowingtis�i�of lot, location of system in�r'elation toEills, buildings, etc, must be placed on reverse side.) NEW INSTALLATION: .(Nonseptic tank or seepage pit,-perMitted if public sewer is available within 200 feet,) „ PACKAGE TREATMENT [ ) SEPTIC TANK Sze-- /l---Q----_ Liquid Depth.-• -------------e 1. lik - No. Compartments--_-_ -_-------------------- Capacity€ �;��Q e --- ?.-Mate-Pial- Distance to nearest. Weli ----------- enc -------- Foundation.--€----- � Prop. Line--------- ----- ACHING LINE No. of Lines-..lC,.-- ;Length of ea h line` - _- ---Total_Length ..` - t` D' Box -�_ --Type Filter.Material Depthssifer Material---I- __-.------------------------------------------------ 41 Distanca to nearest: W61L-l _ -.---_._ undation c . ___. --,-- ---Property Line- Y N } FPAGE PIT [ Depth-�J Diameter-'.. - _Number---_ Z-------- = k Filled es o❑ rl Roc Water Table Depth__ .yf� _ Rock Size-.f�- --- --- - r -Foundation-- r Pro Line... ------- Distance to nearest: Well-------------I - ---- * - -rAIR/ADDITION (Prev. Sanitation Permit#-------- ------------------------- ---.=. -----_.Dati3 ) --------------- -------------------------= tic Tank (Specify Requirements)-------- ----------------- _iposol Field (Specify Requirements)--==------------------- - --- ------------------------ ------------------ ----------------- ----------------------- ----------------------------- A ------------------------------------------ ---;-----:`------------------------------ - �' - ------ ----- 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 San Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents signature certifies the following: "1 certify that in the performance of',the work for which this permit is issued, 1 shall not employ any person in such manner as to become subje Workman's Compensati laws of California." -------- -----------n � BY------- - ------ --- ------ - - --- t o { t ___ _ _._ _ Title. --- (If other than ow rj R PARTMENT USE ONLY' j APPLICATION ACCEPTED BY -- . -- ---- -- �_ _ ATE. -------------- --- DIVISION OF LAND NUMBER--------------= ---- - ATE - ADDITIONAL COMMENTS------------------------ -- ----------------------------------------- -------------------------- --------------------------------- ----------------------------------------------- -- -- Final Ins ection,b ------------------------------Date --- --2.2------------ ------- p y: E11 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F85 2lh77 REV, 7/76 3M