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FOR OFFICE US AppgCAT1PN FOR SANITATION p>rrtnnlT •- Permit No. �° '-S--� -�-l�.Y......-.....f`: {Complete in Tripiie°tel Date Issued .. -.7 •-L. -�� a. . ._...... -- - ....... C`20--5 C This Permit Expires 1 Year From Dare issued C>-71 ?r J +�; 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 existingCENSUS (TRACT Regulations-- 08 ADORE5S�10CPTION -"l.N _ ,Kt> _ .). 11�5�-1�5` 'STC..-----•- Owner s Name $�.........---Phone----- .......... F� _. City .: Address . ........_...1 �--'--- laC2._:. � ... ; _ a ......... t�'.� '-- .............License# -�13_.e bR..... Phone -W- ._� %t Con ractor s Name ...._� a- •- _-_,. _.., Residence Ap'ariment House j] Commercial oTrailer,Court . ,. . installation will serve: 4 a..r - Motel❑Other_..----------------------------------------- Number of living units:__ .._.. Number of bedrooms ..---..•-.GparbaBeGrinder r-S� t Size �'c '•' - -- Water Supply: Public System and name-- 1N `� a q�$ ?_.-'-----�- - -- 5 ` - Private[] ° •Peat Sandy Loar 1�{ Clay Lpam ] t_ Character of soil to o depth of 3 feet: Sand T3 Silt❑ CInY fl. } c, h I Hardpan❑ Adobe{ fill Material If Yes,type 111---------••-; 1 must `t [Plot plan, showing size of lot, location of system �� relation rf publk sswer its available lable wiitthin 200 feet j e,placed an reversejp side.) NEW INSTALLATION: (No septic tank or,seepo9 P permitted �/ Size._�d ----- Li9md Depth --- ...... _.. I SEPTICTANKi'YCompartmentsI PACKAGE TREATMENT [I } �! Capacity{.-a._w.---V16- Type ---------------._ Material. �__je?FMJ�., No. Lin Distance to nearest: Welt .Qar._—/t- ._.........Foundatiwn Line �t . .` LEACHING LINE No. of Lines __qt.-------------_. Length of each line_.-_-- j.Y [ rl _ ...:Y p _ -- JO& Type filter Material .Depth Filter Material �0----' r , 4' 'D' Box - -- 4th Property L ne. --. Foundation .. - Distance to nearest Well . -- Rock Filled Yes i] No�-, --. Diameter -- -_. Number __-.-------- ------ SEEPAGE PIT [ j Depth - < > ' Rock Sizy Water Table Depth __.___.__-_- •_-^•----- _Foundation ---- ..._.. ?rre op. Lu Distance to nearest:Well ----.._....___.____------ , Date _ :- - — - ---- - _ , REpALR/A`pL11pN{Prev.Sanitation Permit# - Y _..._.-_._-- Septic Tank(Specify eq � Disposal Field (Specify Requitement$) --__.----.-."'-'_'-------•---�.__.__,�: - --•------' ._....__._.-- - -- -......---. ----------- -"" (Draw existing and required addition on reverse Side) I hereby certify that 1 have prepared this apPllc°tion and that the work will be dem-in District Holne..owner ar licen- and Rules and Regutations of the San Joaquin Local , ,. - County Ordinances, State Laws, < sed agents signature certifies the following: ennit is issued, I shall not employ arty penen iR such manner "I certify that in the performance of d.e work for which this p as to became subject to Workman's Compensation laws of California." 4 , Owner Virg ` - -•• Signed_.._.--.-----...---------- _ __ _ .._...-.... ------.. . _. ...------------ 7 Title .f_�.._:• . --- --------.._._—._.__.__,..._ r pf other than owner] ' FOR DEpAttYMENT USE O DATE-"-" --..._........ APPLICA71oIJ ACCEPTED BY_ ------ — -- ...... _--------- _-- _ BUILDING PERMIT ISSUED--------------_.-_._----- --------------------- ._..--- —...-_.. :_,___BATE'--. -.. -- 4. ADDITI N L COMMENT _ - tA4. . r pd�eueZ- '>"4" 4 — • ----.......... -------.. Dte-- " 4t._..-'------.._.._•_. Fina nsp --s SAN JOAQUIN LOCAL HEALTH DISTRICT E.H.9 1=68 Rev. 5M