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FOR OFFICE USE: �- APPLICATION FOR SANITATION PERMIT :..:. ........:....::' ':`::_:_._.::_:...... IComplefo in Trlplicate� _ . r_. Permit No. 7S. ...: .... Date Issued z . .. This Permit Expires 1 Year from Date Issued ............... Application is hereby made to the San Joaquin Local Health District for ' q permit to wnstruct and instal! the work herein described. This application t ma'a -, 'n compliance with County Ordinance N " 5319ndsi xir Rules and Regulations. JOB ADDRESS/LOCATION " „•-. -ice___p m_t.Qn...appx... . .-.... ..oi EIlS TRACT Owner's Name ..QI ....................illi ams ................:. ......-----......_......_ ------------------- Phone " 932 Avaloil ��oc�"t��..... .----•..-•-----•.................... Address ............... :......................................................................_...............City .........-•-- ---------------------------------......................_...... Contractor's Name ................... ..License # 22-x,53.9......... Phone Installation will serve: Residence[3 Apartment House 1:] Commercial OTrailer Court 0 Motel ❑Other ...................... ................ Number of living units:___.)_._._ Number of bedrooms es ' 80 ----------------------- -----•----- t Calif. .Water . Ser.' Water Supply: Public System and name - ....,.Private []. •................................a..........:._......._....._.:._.....:._.....:........_.:.--•--..:. Character of soil to a depth of 3 feet: Sand El Silt 0 Clay ❑ Peat Q Sandy Loam 0 Clay Loam ❑ � Adobe El fill ' Hardpan❑ i I Mpterialna If yes,type - (Plat plan, showing size of lot, location of system in relation to well:,`buildings, etc. must be placed on reverse side.) i NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is availoblewithin 200 feet,) PACKAGE TREATMENT [ } SEPTIC TANK f.3 Size-----4.I.... .. ► Liquid De 1 VI Capacity .......i 2 0 0.._ Type pr e c as t__. Materico on cr e t .e No. Compartments .2.•................. r: .... Distance.to nearest: Well .................................foundation :.�:�..........'.-_.. Prop. line .ter..t................. 0 LEACHING LINE S No. of Lines -I......_:---........... Length of each line.--l-00.t................ Total Length ..l-0a T.._._........--. t 'D' Box ....uQ.... Type Filter Material P'aj;�k.........Depth Filter Material --------------18" -•-•---•--•------------- n/.a Foundation 10 , 5 { - Distance to nearest: Well ..._ .. Property Line I................ 9 SEEPAGE PIT ©epi)-i 2�r.r.:•'_.. D1argsc .t._, .n.. Number ....x..............1..... .... tits ... Rok Filled Yes -] No _..:.....Rock,Size l� by 3.. Water Table Depth if . Distance to nearest: Well ......Foundation —1.&J........... Prop Line REPAIR/ADDITION(Prev. Sanitation Permit# ....:..---•:_..._...••.... ........:..::.... Date ................:...I......--.:._._.) 4 Septic-Tank (Specify Reqs irements) ................. l _ ._................... ........................................... ...........................................•--........:..r Disposal Field (Specify-Requirements) ...... ................. ...............:.:.........: ...: . ------------•--- .. --------------------------------- ------------------------- ---= --1 - -•--•....................._--•-•--------•---------.....---- (Draw existing and required addition ori reverse side) I hereby certify that i have 'Prepared this application and that the work wlil be done In accordance with Sart Joaquin County Ordinances, State Laws, and Rules and Regulationsofthe 'San Joaquin Local Health-Disirict. Home owner or liven- sed agents signature certifies the fallowing _=ri r "I certify that in the performance of the work for'which this permit is issued, I shall not employ any person In such manner as to becom ect to Workman's Co ensation .laws of California." Signed ..__...-•- -•----- n ------ -- ---• - Owner BYJ " . Title --------------- Contra.cotr of er owner. f R DEPAIFF&JENT USE ONLY APPLICATION ACCEPTED BY _ .--... DATE .._ _._: BUILDINGPERMIT ISSUED --•----•........... ..............................--•-•.................................................DATE .------.................................... ADDITIONAL COMMENTS .........___.__.----------_ E... ...... ------------------•--------------•----- ----- ..---- - ------------------------------------ •----- -------- -- • -•---------- Final Inspection by: - ...... --...- - • .. ..... -..'.............::..Date k EH 13 2t1 1-68 Rev. 1 SA JOAQUIN CAL HEALTH DISTRICT � 8/74 3M i