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FOR OFFICE USE: APPLICATION-FOR SANITATION PERMIT �. Permit No. ----------'-------- -------------- "" '� (Complete in Triplicate) ----"-- -- , r - Date Issued ...-------•----- ------------------------------ ------ This Permit Expires 1 Year From Date Issue l the work herein Application is hereby made to the San compliance wi h CounJoaquin Local Healih ptyt0 dinan a rict for a No. 549 and existing Rules ermit to construct and tand Regulations. .. �. �. rde m described. This application _ IEcation is ma -. .. �. - • JOB ADDRESS/LOCATION _�.�------ - � � ierQ_. _v CENSUS TRACT ___ I P � �?1-ems -.--------------------- -------------------Phone -------�-------- Owner's Mame --------------- cityc-�! +A- wrNkta Address ----- ---------- ------ — • e --------------------- License # Phone Contractor.5_.Name _---------------=--��. . - � -�.-... r CA- Motel j installatiariwill serve: Residence Apartment House❑ ,Commercial ❑Trailer Court l Motel ❑ Other -------------=------------.::c--------------- Number of living units:......_ Number of bedrooms _---21_____Garbage Grinder Lot Size ..._ .. ._ --- - -------- -- Water Supply: Public System and name ------------------ -------------- -- -: --------------------Private Character o soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ ` Peat❑ Sandy Loam i$ Clay Loam ❑ Hard an ❑ Adobe F-1FillMaterial _.___.---___ If yes,type ---------------------------- i { i t (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side,) f NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) --------------------------- TREATMENT [ ] SEPTIC TANK'V JL] Size------------------------------------ --------- - Liquid Depth I ----------- Capacity PACKAGE T _,ho f} ------- Type �e 0► k - Material_._ __ No. Compartments \ l Foundation ----- ---- Prop. Line I Distance+ to nearest: Well ______` Q____-------------- / -- Length of each line-------7o'---- ------ Total Len __ _y�--------------- ' LEACHING LINE {:j�No. of Lines -------•-�- -------- g � 'D' Box --- ------- Type Filter Material ____ - ---Depth Filter Material S '1 b Foundation. ----�_0.r-------- Property Line. ----_l- ------- Distance to nearest: Well -.__.-,5-------------- I -------------- Diameter ---------------- Number --------------------------._ Rock Filled Yes ❑ >�; No 0 SEEPAGE PIT � ) Depth �. -- i --------Rock Size -----------------------• Wafter Table Depth _. Distanceto nearest: Well -----------------------------------------Foundation -------------------------- -- ------Foundation -------------------- Prop. Line --------- ------------ REPAIRf AbD1TlON(Prey.SSanitation Permit# -------------------" ---------------------- Date ----------------------------------} Septic Tank (Specify Requirements) __________________ .___.---------.------- -------------- --------- -------------------------------------- ".- -------- -------------- F - ---- Disposal rField (specify, Requirements) -"------------------- --- --------------------------------------- I b - - _ " I ---- and req--red a - ---------- (Draw existing ng ...v ition on reverse side) I hereby certify that I have prepared this application and that the work will be done 1n accordance with San Joaquin County Ordinances, .State Laws, 'nilRules and Regulations of the San Joaquin Local'Health District. Homeyownef or licen- sed agents signature Certifies the following: „y j "1 certify that in the perfoiniance of the work for which this permit is issued, 1 shall not employ any person. in 'such manner as to becoTq subject to`WorkniV pensatipn`laws of California." ' Co �.- . _ Owner Signed r -Title ---------- ------ ----------------------------- --- ----------------- --------------------- ------ ------------------------------- (If other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B �Y' •--_ 4'' DATE __... --------------------------------- J BUILDING PERMIT ISSUED ----- DATE -------------•------- -------------------------------- ----------------------- ADDITIONA! COMMENTS + --------------- - -------- .1 1 ------ -------------- ----------------------- --------- ----- == --------------- ----- -------""- --------------------- ----- ----------------------------- --------------------------------------------- - ------ .___."� ' ------------ t7 Date fra'- Final Ins ection b =---- SAN JOAQUIN LOCAL HEALTH :DISTRICT E. H. 9 1-'b8 Rev. 5M.