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C'OR ®I=FIC(: llSE APPLICATION FOR SANITATION PERMIT ................ ••••............................ Permit No. ..................... ' Complete In Triplicate) ........................ ~D Date issued -�1':/.../. ................................ .-_.........:............ This Parent Expires 1 Year From Date issued Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work°-heroin described. This application Isr made In compliance with County rdinance No. 549 and existing Rules and'Regulaflorisi I JOS ADDRESS/LOCATI N .,I� G . .. ....... .... - 3- ........................CENSUS TRACE' �.......... ... Phone � 0 �. Owner's Name . . .. .. ? ..�........................................................ !. .! .............. . . -.. Address .. " .............._ . ..... .............. ..City ................................................................. ...... Contractor's Name --_ t ,---�-•-- ...........................License # c17! k��_-. Phone''�.�`!d�r 1W e railer Court Installation will serve, ales once�Apertment House Commercial [3T {] Motel❑Other.,,,. --•--•--------•-.................... � = ' •' _ ,'"�" Number of laving units------------- Number of bed ooms ----. .....Garbage Grinder-: ...... L'ot-Siie ..............-..................... ....... Water Supply: Public System'and name -------------------............------•-----•••:--------.:.. _____Private 0 t Character of soil to a depth of 3 feet: 4'Sand.C3 Slit❑ --Clay,.0 Peat p Sandy Loam ❑ Clay Loam ❑ . S ' Hardpan 0 Adobe 0 Fill Material ............ If yes,type (Plot plan, showing size of lot,`location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATIONS -(No septic tank or seepage pit permitted if .public sewer.is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC TAMC f { Size...... ....... Liquid Depth _...---......__.. ...... Capacity l�.f�' . _. . . ........ . Material._......__-. .... No. Compartments •---------- . i Distance to nearest: Well- ............Foundation ..-.--... Prop. Line i ............... ire. Total 'Length •-- --....._ LEACHING LINE [ ) No. of Lines --------- ....... Lenoth of eo i ..............:w.._..... ............ . 'D' Sox J....... Type Filter Material -- -__--•-• ...-.Depth Filter Material ....----••---- ................. . , Distance to nearest: Well .-:. '::::..:............ Foundation ........ ............... Property Lln ....................... . . SEEPAGE PIT. Depth Diornwei+.t°............... Number ............................ Rock Filled Yes Q N Water Table Depth : . °:°:�:: �• ..`.... . ...........................Rack Size .... ................. :..._. Distanceito nearest,Well-..........................................�: .. Foundation ..................... Prop. Line .............. ..... )REPAIR ADDITION(Prev. Sanitation I / [Prevration Permit 9� ......'..... . ............•-.._...._. Date ..................................1 _ Septic Tank (Specify Requirementsl. ..................-.......s,-- ............................................................................... .........._............. DisposalField (Specify Requirements) ...................I.................-............................................................,__._...._•-•-----•.._I.. .... _... ....�.................................' ......_.. `.._... •............................................. r- •-- _.. .._- (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 ,Ioagvin County Ordinances, Stafe Laws, and Rules and Regulations of the Sar Joaquin. Local''Health District. Hem* owner or Ileen- sed agents signatureertifies the follbWh g: "I.certify that In the performans1 e f ilio work for which t is perm4 is Issued, t.shall not employ any person In such manner as to become subject to_Workman's C, mpensallon-low's of California:, T Signed . -. �__ ..�. ............................................ Owner By ..-- ............................ - Jitle -.. i Of other than owner) " - 1 FOR DEPARTMENT f ONLY APPLICATION ACCEPTED ISY 2 ............ DATE..- ..... 7' � '�_ BUILDING PERMIT ISSUED DATE -....... , ADDITIONAL. COMMENTS .......... ................ ........ .......................•-...---.......... .._.........................._........ :............. .:.. ................... ............ ......... .......................... . . ............. .......-.'Date .. .... ..-G -:.-.....!...... Final Inspection by: ........... ... •--• - - EH 13 24 1-69 Rev. 5M SAN JOAQUIN LOCAL,HEALTH DISTRICT 8/7h 3M 'tom,..#