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I �.I r FOR OFFICE USE, ............................ APPLICATION FOR SANITATION PERMIT (Complete In Triplicate) Permit No. ..... . 3.'....... ...... This Permit Expires 1 Year From Dale Issued Date Issued ..7.:jO:.73 y S Applicatlon Is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hotels ' desalbed. This application Is made in compliance with County Ordinance No. o214 and existing Rules and Regulations, 1, JOB ADDRESS/LOCATIO ,..Jl!.3'T:J..r::.lF.......� T..Ti,� ............ ... .. . CENSUS TRACT ._s...V-'•••- . Owner's Nome ..........VEA&......DUN.0�..... ........................................ ............ :.Phone .........................I.... ...... Address ._,..... ..3,)3.y.3. . .C...F.... . . 40N.F..TRF9;w ..Cly .. .�*Kry?f.-.r......................................... Contractor's ........................................License sP ........................ Phone .............................. i Installation will server Residence 01cpartment House Commercial ❑Trailer Court )] Motel ❑Other. .. ...................................... Number of living units,.....I..... Number of bedrooms r=-Garbage Grinder IVO.. Let Size ... ...... Water Supply Public System and name . ........... ..................... .................._.. ................ .........:.....................Private�� y Character of soil to a depth of 3 flet, Sand❑ Silt❑� Clay ❑ Peat❑//,�-,,Sandy Loam ❑ Clay Loc Gh� IgA+ Hardpan Adobe El Fill Material ..LVA.. If yes,type............................ } C (Plot plan, showing size of lot, location of system In relation to wells, hintdings, etc. must be placed on reverse side.) s NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) PACKAGt TREATMENT [ I SEPTIC TANK(; Size........................................ . .... Liquid Depth .......................... � s Capacity ....._.......... .. Type .................... Material...................... No. Compartments X Distance Jo neares : Well ............................. ......Foundation .... .... ...........Prop. line...................... ty LEACHING LINE [ ] No. of Lines Length of each line...................... .... Total Length 'D' Box ............ Ty a Filter Material ................:..Depth Filter aterial ............................................ Distance to neares Well ........................ Foundation ....................... Property Line SEEPAGE PIT ( J Depth .._... ............ Diameter ................ Number ...—............... ....... Rock Filled Yes ❑ No ❑ Y ^. It Water Table Dept Rack Size ....................... b ' Distance to nears Well _.......................................Foundation ... ............... Prop. Line ...................... i REPAIR/ADDITION[Prev. Sanitation Permir Date ............... 1 Septic Tank (Specify Requirements) ................................................................................... ..............._ p-............._.......... ..... v.' Disposai Field (Specify Requirements) ..... ,Z�-C.....Gt1e.......6FFniL -NK- --7 N -.-,. "J F '�"'�'-'-• �5_`. ..�F�4rF+.G/iv6._=....._l .'.....z1.6ffTZ.i�� ......cam........./ .....,YD_........P1..T... _ . .... ... . ...........................1...................::............................................:................................................ (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 ')rdinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilan- 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 becoryp sub t to erkma 's ompensatlon laws of California." Signed _ 0 0".., 9".7=m .._.................................... . Owner By _. ...othe... .. ._ _. . . ..... ......__................. ......... ........�. Title ..._. _ _................. ... .....__....................... ' (if other then owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . _..7—( LO..'........ ..... ....................... ..__.._.... _................. DATE ...._.L7... k:!..73...... BUILDINGPERMIT ISSUED _ _.._. ..................... ........... .......................................... .................DATE.......................................... ADDITIONAL COMMENTS _ .......................... "-' .. .. ... .... .... ..... ... . . ................... .. ._ ... ....... ..... ?2 Final In occti by. �. ... .. .. .. .. ... .. .. . .. . ... Date .�.. ..L�4—�...7'.. SAN JOAQUIN LOCAL HEALTH DISTRICT r-- E. H. 9 1-'68 Rev. 5M