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;F utlilq;k Met .�i�f y......................... APPLICATION FOR SANITATION 'PERMIT �,.•3�� ............................................. (Complete in Triplicate) Permit No. .7. 26 This Permit Expires 4 Year From Date Issued Date laaued . ..�.��. 4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the worts herein described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: Irl Z, JOB ADDRESS/LOCATION J2.-.i/-.-DO .. ..........................................CENSUS TRACT Owner's Name ..................... .... .. .... .............. .....................................Phone . �.:. .��_ . � Addresstar.4:1 rr.-�- ... :��_ �! ......._....City ..._v .... ..........................................................`p Contractor's Name . .k .................•--------•-................License # ... Phone-Z0'.e' ,��.: ✓.<11.'f"�. Installation will serve: (/ �esiden:WApartment House Commercial 01raller Court 0 3 Motel❑Other............... Number of living units:.... ....... Number of bedrooms --.....Garbage Grinder ............ Lot Size ....................................... :..., r' Water Supply: Public System and 'name .•...._...----•...................................----............-•••--.......----•--...................Private . Character of soil to a depth of 3 feet: Sand Silt Clay y • p � ❑ ❑ y ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ Hardpan❑ Adobe❑ Fill Material ............If yes,type............... ............ ; i (Piot plan, showing size of lot, location of system in relation to welts, buildings, etc. must be placed on reverse side.) F NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer I available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TANK{ ) Size..& ............... Liquid Depth ........................... ` Capacity . -- Type ._ Material........_..........___ No. Compartments .�:......!..... I Distance to nearest: Well 1A0_..........................Foundationf !_. _ Prop. Line r t 240--1.__--.-.-_ � r LEACHING LINE [ ) No. of Lines _..-•_�•------...... Length of each Iine...'��.............._.._ Total Length . 'D' Box .�-....... Type Filter Material .._.._Depth filter Material .��- .................................o C 0 Distance to nearest: Well _ Foundation ........... Property 'Line .................:...... SEEPAGE Ec PIT f } Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No (] Water Table Depth .........•......................................Rock Size ................................. Distance to nearest: Well ........................................Foundation .................... Prop. Line .........:............. REPAIR/ADDITION(Prev. Sanitation Permit ...........•.......................-........ Date ........................_.._......) } Septi T ..........................................................................:----•--..,_..........._...._... , c Tank Specify Requirements) ..... •.-....a • DisposalField (Specify Requirements) --••--•-••.............................................................•.._-....................................:.............�.. _..... ......................•--•----------•-----•!-•-....-•••••••-.............._....-•---...........---•..-.•..----._....................___..............._. _ ...._ . . --. .... ._ ,, ..... :..#....................... .........._..._........._...............-••-... ..................... - - ...._..... Draw existing and required addition on reverse aide) 4, 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. Hayne owner or licen- sed agents signature certifies the following: "I certify that in the performance of the work for whiAh this permit is issued, I shall not employ any person In such manner as to become subject to Warkman' Compensation laws of California." Signed . f .' .................................................... owner By ..............................................._.. .....................-............................. Yitle ........................................................................ [if other than owner) , FOR DEOARTMENT USE ONLY APPLICATION ACCEPTED BY ........... ..W_............ ,.........,...........:.............,............................. DATE .... ../. ._ ...� ...:....-: BUILDING PERMIT ISSUED .......DATE ................................---.........--•---•....-. ........ ADDITIONALCOMMENTS ............................_-...-.............:.. ---------..............................._........................... ............................................•.......................•................................-........ ............. .............. ......... ........... ..... ......... ............. .................•.......................... Final Inspection by. ................ ..._..... --.........---........A:--•-........Date .-.. .. ,.. . .,� ... ......... EH 13 24 1`60 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M `F4 J