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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 3DPermit No. .................... {Complete in Triplicate} , ...................................••..._._.._...._.:-- c Date Issued .............. ....... ------- This Permit Expires it Year From Date Issued ../ J .. .:. l-74-ssotr7 � Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, This application is mode in compliance with County Ordinance No. 549 and existing R les a-d Regulations. JOB ADDRESS/LOCATION,....a_ n - O&e° ` - S S TRACT. - ` Owner's Name � �• ..tLL! Address ... . _.G'7 '� ........ City .................•------.....__.._.......--•--•.....--•- # ----- Contractor's Name _._._... .. rk.--- License # -. - - Phone . Installation will serve. Residence E] Apartment House C1 Commercial]'frailer Court Motel ❑ ............................................ i? I Number of living units:............ Number of bedrooms ............Garbega Grinder .._..._.__.. Lot Size ...1... _..._.. Water Supply: Public System and name ........ .................... ..........................................................Private Character of soil to a depth of 3 feet: Sand ❑ , Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam Hardpan ❑ Adobe ❑ Fill Material ............ If yes,type ............................ Plot Ian showing size of lot, location of. system in relation to wells, buildings, etc. must-be--placed on reverse-side. ( i' N• No septic tank or seepage it ermined if public sewer is available within 200 feet;) F NEW INSTALLATION: ( PP p '� . PACKAGE TREATMENT [ j SEPTIC TANK,[ j Size...- -.X--r x--l.�............... Liquid Depth . .- Capacity , TypeCompartments„ __-- No. ... -----•... Material- -'” "�• .. ... ........... Distance to near��eSt: Well .._., - ....Foundation ..__ r;L�...••--•- Prop. Line ...5................ r LEACHING LINE [ ] No. of Lines ....sem.......••-•--• Le4h of each line-------- ............ Total length ..lLO- rZ ............. 'D' Box ...�rJType Filter Mote?iol ._.Depth Filter Material ./.f..........,..............:-...... :... Distance to nearest: Well .............I--._-__.._. Foundation _.._....--•----------_-. Property Line '...------------101�1 .... y� f l [ j Depth 3�_ X/ Diameter .-.}----•----... Number ..._. ................. Rock Filed Yes No ❑ 4 Water Table Depth .1.................... ........Rock Size k Distance to nearest• Weil / .L �. . .............. Prop. Line .. :............ Foundation REPAIR/ADDITION(Prev. Sanitation Permit 56E ......................... l . Date : !7. ' Septic Tank (Specify Requirements) ---------------------------------------------------------•--•........---------•.......------•........------_•......--•-.._..•--•-----..-_-- 'u, Disposal Field (Specify Requirements] �. a r -------••........................................... - - .....------....._.__._._........--•-----.....---._.._._.._...........--........_._........_._.._._...._.._._............_..._._...... (Draw existing and required addition on reverse side) . `i I hereby certify that I have prepared this application and that the work will be done in accordance with_ San Joaquin 1p4 County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Iitan• sed agents signature certifies the following: 4 "I certify that in the performance of the work for which this permit is issued, I shall not employ any parson in such manner as to become subject to Workman's Compensation laws of California." Signed Owner BYTitle ..................... . ........... ............................ (if other than owner) iFOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY ...,.., ... . ............ .......... -"*... ...... .......... BUILDING PERMIT ISSUED .....-•--•-----•••--- .......DATE ..........................................--. ADDITIONALCOMMENTS .......... ........................•---•---------......------.......................................................... . .. ------•-- ••....-__--- lq ..-•-................................................................... ---.......--------•--.... ..... ..------_-- •-•--_. .............................••---••-• ._......... ......__......- ----•--------_..-I................•••••-_.._..•. •---=-•-•---...--•-- ................................. ................... , ........................................Final Inspection by: ........................ Date 4. SAN JOAQUIN LOCAL HEALTH DISTRICT 7/723M