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FOR OFFICE USE: APPLICATION F6R SANITATION PERMIT (Complete in Triplicate) Permit No. ..................... This Permit Expires 1 Year From Date Issued Date Issued ......... ... . .. 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 V lianoe with County Ordinance No. 549 and existing Rules and Regulations: N nor Alha'br.. & Mor4 LnJOB ADDRESS/LOCATION,. .�. .... . ....... ... .......... . ..................... ....................�........e. ...CENSUS TRACT ..................... Owner's Name ...Tv RnV S .................... ................................. ....... .. . ..................Phone.931-2254:.. .... .. Address ..................P•ds... fr?,>II`..7.6 ...................................................City $tOCktt3it"Lt....!"a"....95.M7....................... Contractor's Name ..Ike. $.. Septic TATik..Sor...................•..........license # .12703....... Phone ....E6n)+:5271.... Installation will serve: Residence.R Apartment House 0 Commercial QTrailer Court � Motel ❑Other ............................................ Number ofliving units:.... -..... Number of bedrooms 3......Garbage Grinder :. ja `Size .::..3QQ!af;2 ................ Water Supply:Public System and name .... Private eq NS Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ --+kmdpan❑ Adobe 8 Fill Muterla) yes,type (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feat,) PACKAGE TREATMENT SEPTIC TANK fC] size.....gX17 54` !......................... Liquid Depth .....51*. ............. Capacity .1 200........ Type pregUt... Material44nupt.t -No. Compartments 2............ Distance to nearest: Well ..... 100....................Foundation 1 .......:.:.. Prop. Line ................ LEACHING LINE (31 No. of Lines .....2................ Length of east line::.01.1.................. Totai'length 170!................... 'D' Box Y!e;.... Type Filter Material .XQPk.......Depth filter Material T!.. .......... .............. Distance to nearest: Well 100............. Foundation ....i.6............... Property Line ...art........ ...... SEEPAGE PIT Pq Depth 2-5............... Diameter .....33.... Number ........,2................. Rock Filled Yes (3 No Q Water Table Depth ...... . .. � a: ...............Rock Size ......I.P12. .... Distance to nearest: Well 104 ...... ............Foundation ....1.0:.,........ Prop. line ..?.........»..... 1� REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................I Septic Tank (Specify Requirements) ...................................•--........... .......•.......................................................... ................... Disposal Field (Specify Requirements) ........................................................................----....................---..... ............ .......... .....................................................:.......---•---•----•-•-.............. ...... . . .:........... ........................ ........................ ----....... ...... ..............---................. ..........:...._.:........--.. ................................... (Draw existing and required addition on reverse side) I hereby certify that 1 have prepared this application and that' the work will be done in accordance with San Joaquin County Ordinances, State Laws, and Rules and Rogulations of the"San Joaquin Load Health District.Mom* owner or Ilcon- sed agents signature certifies the followings "I certify that in the performance of the work for which this permit is issued, 1 shall net employ any person In such mamor as to become subject to Workman's Compensation laws of California." Signed .. ......... ...... . ...... ......... .............................. Owner By ......... Le *le e Ikerd ............................ .... Title .Gontraetor .. ............................................ (If other than owner) DEPARTMENT USE ONLY APPLICATION ACCEPTED B ....... ....... DATE BUILDING,PERMIT ISSUED ........................................................._.... .... ...... ..DATE .......................... ......... ADDITIONAL COMMENTS .................... ..... . ......................... ....._... .. ... ......................................... ............................. ............... ........................._.......................... ..... ...................................... ....................... .. Final Inspection y= �..f �„ -. .... .......: .. ....Date ./1.� ,rx' ir'� .......... <C7/t- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H.1.3 241-'68 Rev. 5M 7/7213 M