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FOR OFFICE USE: - FOR OFFICE USE: ..................................•-...._....:. APPLICATION FOR SANITATIOAi.'PElt1Mi[T (Complete In Triplicate)'� Permit No?7:7� .A Date Issued_(-:10:77 This Permit Expires 1 Year From Date lsaceed Application is hereby mode to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No.,519 and existing Rules and Regulations; I ler)A JOB ADDRESSAOCATIO T ..... .....__y, .w.,. ,... . w _-CENSUS TRACT--._ Owner's Name........ �. '� Phonb,!. ...:........................... } - Y Address............................ - •,� � •- City. _Zip.............................. Contracto:s Mame._: : _ License :. ' ..... -.. ---- one Installation will-serve: Residence Apartment H'0 use Commorclal -o rt I Motel E3 - ostler_ ...._.. Number of living units:....... Number.of:bedrooms.._--GarbageSiie.._., ........_ z = - { Water Supply: Public System ond'name__.. - ;_..-___-, . ................... `_.... ._--- ...... • -t-- ......P to Character of sail to a depth of 3 feet Sand❑ Silt❑ Clay❑ : Peat❑' Sandy Loam Clay Loam❑ 1 j Adobe'❑ Fill Moterial _. .fyes,type---,Hard an (Plot plan, showing size of lot,loFation of.system In relationto wells,buildings,'etc:must,be placed on revcarsa•side.} NEVA INSTALLATION:" (No septic tank -orere it pit perJ.0 if u6lic sewer is ova'Able within 200 feet,j t a' PACKAGE TREATMENT' j I SEPTIC TANK I �u --------' t _ LiquidCa cI ----pa tY- ......T � rYPe• --- --- • -•--._. terial_:., J .`.�O .� F� -- ..... :. Distance to nearest:Well t ,,-•-•--,... .. , . -•-• Q ri------•-•.. .' undo Ian.._. prop Line.:_._ .. ....... T LEACHING LINE (J�Na..of Lines-.......• j - _ Lersgtfi of each line..•........ �., . ;.focal Length----- i - ' :D' Box._.__.t•--.Type filler Ma terial._.....5.-_M_6epth Filter Material..!--•__!_. s 4.4.1 Distpnc®,to nearest:Well..r----=-- ------- .....Foundation._.:.. .- Property Line.__.� ............... SEEPAGE PIT Depth'. �... . ,,..c....:,. ._; . , ,- t- D p + .—Diarneter- :..... ;----Nurnt er_....•.. i_ Filled Yes Noi _ Rack F' ed Rock Si ' I Distance tonearest:'Well...:....< 0....-.. t.:.....Foundation--..•-- ..._..�'__-- _.Prop. Line.._. ...............or, o JMPAIR/ADDITION{Prey. Sanitation Perris t-#....:...:...:...:.. .. ' ate.......---------_.. - -------•- _ . . ..... Se tic Tank.( i ice uirements Disposal Field (Specify Requirementsi....::........ .r_..... I -•-•---------- = •- •- .............. e _ _ ..............K ................................................ .................. t (Draw existing and required dditiorti on reverse side I hireby certify that I have prepared this application and thpttfie vrrork yvFll �e done in aeeordee with San Joaquin:Count an r Ordinances, State Laws; and ;tulles and Regulations of the SanJoaquin Locall Health District. ilwne owner od ' signature Certifies the following: . y r licenseagents "i eer/ify that in the perfw,iieine6'of #fee work for v+►fiich this petniit is Issued, i shall net employ any person in such manner as to become subject,to Workman's Cam sailors low .b# California." . r Signed............... --------- -------- . .............. •Owner I $Y -- ----- ---- - --...--•---•- Title..... (If'dfher than owner} :.._ .• _ �J►�,. ..•..... • t _ IaOR DIEPAII< muff USI:'flNLY s APPLICATION ACCEPTED BY------- _ DIVISION O . ..:...:.. _......._.. . ......... ..... .. �LAND NUMBER;..._._.......:........••---_--•-•_-•--- • . :. .: ...............•. :---....--•-- _ DATE__ .f.. _.. �• ''f •-------- AODITIi?1VAL COMMIrNTS............:.. DATE......._._.------- ...... RFinal Inspection by:• -� . _ _. ..-........;�.`.................•----'-._..__... -..-... -............•_-. ... ...._ Date../.1_ _ � .......... �" 18SAN JOAQUIN LOCAL HEALTH DISTRICT F85 21677 REV.7/75 3M -