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FDR OFFICE USE. APPLICATION ICOR SANITATION PERMIT S :.........: . Permit No.e7-�_.lad.7 (Complete In Triplicatel ,. ......................... ......... •-• This Permit Expires I Year From Oate 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION .. C�C� ..................... lvsus TRACT .................... Owner's Name .._ ?-:. ....... ......---•..._..---••-------•-----....-- ................ --•- Phone ................................... .......................... .. .. Address __. 7.f. .. '.. --• . city .......... Contractor's Name . C� y., s.,;=�•�- I............................z........License# ;S057 ._Phone ... Installation will serve: Residence partment House f] Commercial j]Traller Court E] s` Motel ❑Other------•------- ---------........ -- -....... f Number of living units_____________ Number of bedroom; Garba a Grinder + Size ?' Water Su ! Public System and Hama ..---.... pp Y i ......................:..Private�� •,.. Character of soil to a depth of 3 feet: Sand t] Silt Q Clay {3�-Peat[] Sandy Loans �- Clay Loam [3 Hardpan[i Adobe 0 Fill Mcterlal ............ if yes,type....:......... (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 sewer is available within 200 feet,) �r PACKAGE TREATMENT ' [ ] SEATIC TANK ] U Size................................................ Liquid Depth .. No. Compartments _ Capacity --.....-•-----•----- Type ------------7. Material....................... ..:............_......-� Distance to nearest: Well ..................................:.Foundation ...................'_. Prop. Line ...._.._....:________.m s , LEACHING LINE f I No. of.Lines _:....-•---------------- Length of eachline............................. Total Length ----.___.......__..____..-••. 'D' Box _..._._. --- Type Filter Material ....................Depth Filter Material Distanceto nearest: Well ......__________________ Foundation ----------.. ........... Property Line ....... SEEPAGE PIT ' [ ) _.• De•th p ------------- Diameter ________________ Number -------- ........ Rack Filled Yea ❑ No � Water Table Depfh` ........- -•----...---•----•------•-•----------:...,.._._Rock Size ...................... Distance to nearest: Well .Foundation ...._. Prop. Line REPAIR/ADDITION(Prev. Sanitation Permit# ...._.... -- -- Date ----------- SepticRequirements) = I Tank (Specify Re uiremenrts .. . ecify RequiremDisposal Field (Spents) d ----- -•--- . . � r f .................,,..__-__-___-_______-.------- ------------------,.._-__-__-____----___-_____.---.______--_-_-_.__................-#..._..._.____..........__..__........................ ................ --- f(Draw_existing and required addition on reverse side) ! hereby certify that I have prepared this application and that the worm will be done In accordance with San JoaquM" County Ordinances, State Laws, acid Rules and Regulations of the San Joaquin Local Health:District. Horne owner or Been- 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 peirson In such manner as to become subject to Workman's Compensation laws of California." Signed ...... -------- -•---------------_--_ _----•----- Owner BY -------------- -------------•----••--------------- Title' ' 7 ether than owner) y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ...... ----------------------------------------------- DATE .. -- . -.. /�. ------------------- BUILDING PERMIT ISSUED -•--- --- --------------------_------_---- DATE ADDITIONAL COMMENTS . !tea .q� _c ry-, ---- -.-... .............. ........... ...... .... :.. .. --------- ------------------------ - ------- ---- Final Inspection by: ......................... Q i te EH 13 24 1-68 Rev, 5M SAN JOAQUIN LOCAL HEALTH DISTRICT $!74 3M