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` FOR OFFICE USE: , APPLICATION FOR SANITATION PERMIT 4 ._ .._........... -------- ---------- g ICamplete In Triplicate) Permit No.X77 Data"issuer ....1 ........................... .............................. This PermltExpires I! Ysarl`rom Dahlssued .z....... ;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. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .-...,5.31-3 E webe . __... ................... ..._.......,........ ...... .............. Owner's ....-..CENSUS TRACT ........:. . . Name o� ► 5 : --...__-- } ' one Address . .. �3.. _.'...., e�0 110 .'City ...5 © K,T �!/-.h....,.......�..,........ Contractor's Name e. NE' �'' . Q ... License # Phone a 3 .'1.Q.. ..` Installation will serve: Residence(XApartment House0 Commercial QTra#ler Court t Motel ❑Other Number of living units:_.)------ Number of bedrooms--:_ .:.-:Gare G bagrinder _70: lot Size b ....�!. ................. Water Supply: Public System and risme ' � Private Q :.. ........... ........................ P i ate Character of soil to a depth of 3 feet: Sand-0- -Silt Q Clay ❑ Peat❑ Sandy loam 0 Clay Loam Q Hardpan p Adobe:Q( Fill Material ............ If yes,type ............... .............. i 1 .(Plot plan, showing size of lot, location of-system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public severer is available within 240 feet,) PACKAGE.TREATMENT [ ] SEPTIC TANK f) Size..:;V.__X..�,_.X.-I Q-'................... Liquid Depth .....-5............. CaPacitYQ© a . • TYpe .. .. ........... . Compartments .... ............ t Distance.to nearest: Well .....:..........Foundation /.-. ..:..---- Prop. Line ....S............... LEACHING LINE No. of Lines Length of each line.._......YS.._.....:•._...Total .length .........f.7i D' Box .._._....... Type Filter Material ._�h 4 .:_.Depth Filter Material .......1 Distance to nearest: Well --- - -L .. Foundation ...... ....:__._.;, er n- .-----••----- • `SEEPAGE PIT ( Depth ... r..� Diameter .. Number ...---------- -`A............ ock Filled Yes o Water Table Depth. ------- •--- ' ......... Rock Size ......_: :...I........ r Distance to-nearest. Well _ ._W�' I ............ ---.:.� .:�.:.... Prop. Line :................... REPAIR/ADDITION(Prev. Sanitation Permit# ----------------------_- -- -----. Date'--.-------- ...._.•..._) e T E Septic Tank #Specify Requirements) ------------------•- ------ ............._;................................ Disposal Field (Specify Requirements) --------•--•---•- ---------------- ------------- -- ------------------ri---•------- ----------- ....._. ------------------- .............:............................ --------------- ----------------------- ---------------- _.._.. ing and on on se 1 herebycertify that I have prepa d this a plication and required that theworkwill `be side).... In :accordance with' San fY h p Pp Joaquin County Ordinances, State Laws, antl Rules and Regulations of the'Son Joaquin Local Health:District. Home owner or licen- sed agents signature certifies the following: "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 become subject to Workman's.Compensation laws of California." Signed . • ----..... ----- Owner - ( C= {/` --- ------------ (lf other than owner} - Title.= _ �._... �.- R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY '-....._. DATE .,-.,DATE ---- ---------- BUlLDING PERMIT I5SUl:D ...... ' .. :._..DATE .................:..._ -----•--• - --- ADDITIONAL COMMENTS .... ..... ---"-- ---• ..---------- - 1 ` 1 FinalInspection by: ----------------- ....................:...................---------. _ .... _ .............................. ........ --- -- -• .. ... ---------------• -----------•.-----...---- EH 13 24 1:-68 OAQUIN LOCAs: HEALTH DISTRICT 8/7}J 3M