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FOR OFFICE USE: APPLICATION ICOR SANITATION PERMIT 6 _.. .� .......................` .... .. .. tCompleb in Triplicate) Permit No ...�.. :3�v This Permit Expires 1 Year from Dato lstrred Dab issued _ r6...... 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 made in compliance with County Ordinance No. 549 and existing Rules and Regulotionss Jos ADDRfss/L 603 _ :.... l�.L „ ._. ........................ �E:Nstis TRACT ... 'e . Owner's Name 7P . V - N�......C' - ... ..................... ... ............. .......I... .Phone .3koe'm.z6 .... Address .._...... ......L. ^/�}/'� ........................City ..... . '. 0....._.......:._........ . ,pe.� - Con#rattor's Name -- ''i ��---.�` �,�}�iLt��.sX ....................license ilf .c �1`� �.... Phone ... �C2 . Installation will serve: Residence&J(p'artmont House 13 Commercial OTrallor Oma 0 Motel p Other............................................ .► Number of living units:............ Number of bedrooms -_.....Garbage Grinder ............ Lot Size ............................................ Water Supply: Public System and name ........................................................_-..................................................Prlvab 0/. Character of soil to a depth of 3 feat: Sand 0. Sift d Clay Q Peat❑ Sandy Loom{Clay Loam Q Hardpan❑ Adobe 0 Fill Material............If yes,type.... .......... .... (Plot plan, showing size of lot, location of system in rotation to wells, buildings, etc. must be placed on reverse sloe.{ NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,( PACKAGE TREATMENT 13 SEPTIC TANK I I Size................................................ Liquid Depth .......................... Capacity ------ ............. Type -------------------- Material............. No. Compartments ....... Distance to nearest: Well ....................................Foundation ...................... Prop. Line .._..... .... :.. 0 LEACHING LINE [ j No. of Lines ----.--_-_------_--. Length of eachline............................ Total Length .--.-•...................... %/ 'D' Box ............ Type Filter Material ....................Depth Filter Material ............................................04 Distance to nearest; Well ................... ... Foundation ........................ Property Line ........................ SEEPAGE PIT [ ) Depth ...... .. .......... Diameter ................ Number ............................ Rock Filled Yes ❑ No C rn Water Table Depth ................................................Rack Size ................................ Distance to nearest: Well .........................................Foundation ................. Prop. Line .................... REPAIR/ADDITION(Prov. Sanitation Permit# ........................................... Date .......................1 - Septic lank (Specify Requirements) •--........ .' -.._._.. �.... AL :....I... 1 .. (L ..._ � m...--a Disposal Field (Specify Requirements) .......... 0.___. - e, . . _. �, y..... -.- ................... - ... e ........................................... ...g,F,Q.:../.� ------------------------------------------------------------- ---------- ------------•--- ---------------............................................................................................. (Draw existing and required addition on reverse side) 1 hereby certify that I have prepared this application and that the work wpN be done M accordance with San Joaquin County Ordinances, State Laws, and Rules and Regulations of the Sam Joaquin Local HeaNh:District. Nemo owner or llaw sed agents signature certifies tho 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 io Workman's Compensation laws of California.,, Signed ............. •--- ----•- - Owner. . Title ' -? 4............ I other than owner) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...................•----...__.._.........._.._........._._... DATE . - .. ..._-.-.-._.....,......; BUILDINGPERMIT ISSUED _..--------_..-- ----- .................................................---_..........DATE __-..-_...................... ADDITIONAL COMMENTS ...._.....----•-------•.................................•-...•.... - ----- ---. --_--- --------- ------- .......................................................,-.............. ................-.........---- ....... _....---•- .._.... ' - ----•- - ------• ...... ....... ------. ....._....... .................... . . .. .. ..----•------•. .. ............... Date .- •----- Final Inspection by: .... . EH 13 24 1-68 Rev. 5K SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3m