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APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: Permit No,. --------------- ir-Q- ' (Complete in Triplicate) 3 t Date Issued - -------- : s. -------- -- ----- ----- --------------- ---------------�-._...•,---Thrs Perm�t��Exp�res.lMYear_From_Dnte-{ssue --�-.�.�------ .� County Ordinance No• 549 and existing Rules and Regulations, I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein App :t described. This application is made in compliance k ------------------------ !7 :- F CENSUS TRACT ` -------Phone -� ��------- 1 01. JOB ADDRESS/LOCATION -=----- -" Owner's Name ' ---------- p f Y =----- ------------ ----- ---- i .eR r Phone ----------a-, 1..". Address - ---------- - # �, - � � s tense #l-4b�// Contractor's Name -_.:----- s�dence C3portment House'[] Co�I mercial ❑Trailer Court `❑ _- - Installation will serve: i - G- --Other --- Motel "-' ! �-.-- Lot Size i -- Numberof bedrooms Number of living units - Private ❑ Public System and n me ----------- ---------------- i �' Water Supply: Y Clay Loam :I] Character of soil to a depth of 3 feet: Sand's Silt© C► y ❑ s Peat❑\ Sandy Loam ❑ Y e ------ ------------- k � � Adobe Fill Mdterial "_----------;1 Y�,� p -------- � � 1Hardpan ❑,.,may } ,i ells, l?�ildings, etc.Tr�ust be placed on reverse side.) C� f ,l �. } I (plot plan, showing size of lot, location of system in r erm��f public sewer �sngvailable within 200 feett ! ON: (No septic tank or seepage pit p {� # NEW INSTALLATION: i ------------------ �'-- - Liqu'id Depth -------------------- SEPTIC TANK'[ ] Size-------'M--•-- , PACKAGE TREATMENT 17 �'' I -Type__--•--_---- Material-----�`- �� No. Compartment ------- Capacity ' P Y - Prop. Linen,"------------- . Foundation.------------------ - Distance to nearesfi: Well ------------------------------ �� -----.�...:_�---- -- Total Length i - ------- Length of each line--- LEACHING LINE [ ] No. of Lines ----- i`` --�l----------Depth' Filter Material -�---- - --------- -=`-----•-----•-----"--•- 'D' Box ......... -------I... Type Filter Material -_- l E I 'i / Property Line -------•--•-------•"---- Foundation ----- ------ Distance to nearest: Well __---r s Filled Yes [I No 0'! Rock umber '-�---- ---- ----- ------ � SEEPAGE PIT [ I Depth„ �� --{---=.-•--------Rock Size -------------------------------- Water ,Table Depth --------------- -------- --" i ----- I ---- >Foundation,---- ---- ---- Prop. Line _.. Distance to nearest: Wel! ------------------ i � . f } _ REPAIR/ADDITIONIPrev. Sanitation Permit# -_,-:::��.;;�_--.-,�--�-�:""--=_-�-t --- Da#e ----------------------- ' Septic Tank (Specify Requirerinents) -------- ---------- --- ----------------------- ------------------ - -----------"------- Q Field {Specify Re �irementsl ----- ------- f------•- - _ --_----- ---------------------------- Disposal •----- - - ---------« ---- ! - - ----------------------- ---- ---------------------------------- -- - - ------------ (Draw existing and required addition an.reverse � e-.,-,.---' l hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, Siate Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: person in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any as to betome subject to Workman's Compensations aws of Califo knia." l�i � fit,*,Pete Owner Signed -- ---- ------,,:i Title -- - ---- ---- --�-- --- - - BY - -------- ------------- ; (!f other than owner) F R DEPARTMENT: USE ONLY /� /� ------ ---------------------�---------------------- DATE ---- -- - APPLICATION ACCEPTED BY ------ ---- ------0------------------------•--- ------------ DATE -------- - ---------- BUILDING PERMIT ISSUED ------------------------ ------------------ -- "" " ADDITIONAL COMMENTS -------------- _ ;� f _ - --- ----------------------- ----------- - i! --- ------ Date . ------[--------- ------------------------------------- -------- -- $ a Cit. Final inspection by: -- ---- - ---- -- SAN JOAQUIN LOCALI HEALTH DISTRICT it E. H. 9• 1-'b8 Rev. SM F --