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FOR OFFICE USE: .......I................. APPLICATION FOR SANITATION PERMIT FOR OFFICE USE: ........................................----------- (Complete in Triplicate) Permit No. -----------_.............. ......... This Permit Expires I Your From Date issued ----------___ Date Issued.../-///- Application is hereby made to the Son 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.549 and-existing Rules and Regulations: JOB ADDRESSAO, TiN.. . _4 ......CENSUS TRAC7 r ler Owner's Name.-.- ------- ---- .... ... ........ Phone-,", S74Z ------ ---- ----- - Address__,1_41Z City—— ........... ...... Contractor's Name. -------License #_.c. ------- --- --Phone,. lnstcillofion will serve- I I .. ptnousHo3s, Co-rr;1 F a mercial Trader Court'E 'Other............ ....... ...... Motel +'-- Nu' units:. .... ._-mber of living ur .-Nurni -rin if I ,- , . bager G. der.,.......4w.:-Lot Size_.____ ----- i. - Water Supply. Public System -------------------- ond'nan ------ --- ........ ------ ..........--------Private Character of soil to a depth of 3 feet. if Sand -Silt Clay Sandy Loom Clay Loam r* _" . - N, . . r�.. peal Hardpan ; Adobe 0 ��tEFA r:/MV a t e r i a I -------- ...if yes, type ...... ---------- Plot plan, showing`ize of lot, location-ofsystern.'in relation to-wells, buildjpgs�29tc.must be placed,on reverse side.) `NEW IN {No tank,-or-see(N' J�, see ge pit rmitted if�6bj: 1C.'se"wer is available within 200 feet,} ',,PACKAGE TREATMENT I' SEPTIC TANK -fir,------------- Si ze,--- ------ _- --------Liquid Depth 4 - -- ------- Compartments_: Colpacity/14 ell- p A - ---- ------- ---------- Distance to n'earest. Well e t _.j ......I.......Foundation_ Pro'p4 .!- 4*EACHING LINE of L. I � 'I : , -,-, , r* . ...... Len6th of each lina..2 7e _Total, Length.../- "ID"Box )N. e+�`Iter M 1 71 ------- -Typ P _.��pth-Filfier Material._1,4p ............ Distance to nearest. Well. ..............Foundation_................ _.Property Line----- -- --- *-SEEPX6�-PIT 6e th. dd pi arneter -------- ....... Rock Filled Yes ] No Water table bepth-, -4 ------------ �Roc Size,.......... k 7------------------------ to neares't:'W611, _d' ; - - ation... i-----------_------_ Prop. Line._.I?� . REPAIRADDITION (Pre ,. Sanitation Permit jo v Septic-Tank-(Specify Requirements}ire�nents) ........................... ..................... ;Disposal Field (Specify Requirements) . ' ........... ............. --------------- ------------- _...... 4 : ----------- ----- . ............ ......... ............... .......... .............. ------------------------------ - ---------- .......... A I ......... .. I` ........................... .................... ............-------- (Draw 19�xisfing 'r1d n;� 7 e addition o reverse' ' side) uir d n I I hereby certify thata cition and that 1 have prepared this OPP r", lithe work willfbe done in accordance with Son 'Joaquin Courty Ordinances, State Low" and Ru[es. Laws, ,and Regulations of, the Son Joaquin Local Health District. Home owner or licensed agents signature certifies We following: certify that In the performance of'ihe work for which this peirmit is issued, I shall not employ any pars.on in such manner as to become subject, to Warkinan's Compensation, law's of California." Signed.. ---Owner By_ ........ .. f o*er than'owrier) VARTMENT USE ONLY APPLICATION ACCEPTED Z_ DIVISION OF LAND NUMBER'�' ?------------------------- ---------- ------ .......--DATE.-,-- ----------- ---------- .... ...................7........ ................. ------ ...... _.DATE..... 4 ...........I......... ADDITIONAL COMMENTS ----------- ........ ...... ------- --------- --- ------ - —------- ---------- -------- ............... --------------------_--------------- ------ ----------- ......-•-------.- ........ .......... ............. ------------ ---------------------I......... Final Inspection ----------- ----- ----------- . ........... ................. EH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 21677 RM 7176 3M