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�_i (Complete In Triplicate) Permit No. ...7.............. <br /> ......... [ <br /> ................................................ Data Issued ..l a-is_7C <br /> -—•_-.......................:•._........._............ This Pannit Expires t Year From Deas It-sued <br /> t� relay made tc the San Zoaquin Local Health District for a permit to construct and install the work herein <br /> ' describ d, iii{Ig pp <br /> on Is made In compliance with CC unty Ordinance No. 549 and existing Rules and regulations: <br /> i N ,�. ...............`.. ......... .... . _ .i< ..............CENSUS TRACT ....................... <br /> Owner's Name : �..J: .E '. -: ... ............................................._....t.'.¢.--•-•--•---...... hon .....----_..... <br /> Address .. `- .6...... •-_. ................. ......city--� ... -- . . ....- -............ <br /> --------- <br /> R Contractor's Name.... .__ tli:� __....... & .=.. . .....- .._...........License # ......,............... Phone .�. �..._....._�..:. <br /> Installation will serve,` Residence 0<0rtment House fl Commercial[]Trotter Court ❑ <br /> Motel❑Other. <br /> Number of living units:_._-(_..__ Number of bedroarns ...� ---Garbage Grinder ----------- Lot Size <br /> Water Supply: Public System and name <br /> Character of soil to a depth of 3 feet, SandX Silt❑ pay ❑ . Peat[ Sandy Loam (3 Clay Loam ❑ ' <br /> Hardpan❑ Adobe❑ Fill Material............if yes.type-•--..._..-............. <br /> (Plot plan, showing size of lot, location of system In relation to yells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ j SEPTIC TANK 1� r Size_��.i � .=�.. ............ quid Depth .....:2.-.._-_.�_.,...-.._ <br /> Capacity _ .1' ...... Type `� `" Material-Li:. '. '."' No. Compartment: _.� <br /> s . <br /> r Distance to nearest: Well' _ .....S�...... .:e................ Prop. Une <br /> LEACHING LINE [ No. of Lines � .._... Total <br /> " }.; <br /> v <br /> `D`Box ............ Type Filter aterlal _6110epth Filter Material ... ........ , <br /> Distance to nearest: Well .. �3.�.. Foundation - �.r...._.... Property ,trio <br /> 3 <br /> SEEPAGE PIT: ) Depth Diameter ------_-_____.• Number _ Bock Filled' Yes ❑ No Q � <br /> . _ .. <br /> rWater Table Depth -•-- - _ --.Rock Size <br /> x Distance b nearest: Well ...... . __--- ._Fuundatian .� Prop. line <br /> IkEPAIVADDInGN(Prey.Sanitation Permit .._Y-............_.._. ..............:_ Date <br /> Septic Tank (Specify Requirements! ................ <br /> -.-..... <br /> _r..........:. . .... <br /> -----....-....--...._ ...._:-:................. ._....:..�-------------- � <br /> Disposal Field (Spedfy Requirements) .......... -.r...... -----_-------•--------------. -----------••------- -------- <br /> ­------------------- <br /> ---------------------------------------w............................................................._:........-------------. .._.._..r................._...�..._.._.....------• ------------ <br /> - .......... .................-................_...........� -•--------...--------. <br /> (Draw existing and required addition on reverse sada)• �...._.-_.............. <br /> 1 hereby certify that t have prepared this application and that the work will be done to accordance with Saes Joaquin <br /> County Ordinaric".'.State'Laws, and Rules and Regulations of the Save Joaquin Local Health District. Horne owner or RCM- <br /> sed agents signature certifies the fotl*Mng: <br /> "I certify that In the performance of the work for which this permit is Issued, l shall not employ any person lin such manaw <br /> f j <br /> cis to bsearii6(ect to ti'�f, rk�san'kampensadon lays of California." <br /> Signed <br /> Owner <br /> L.� <br /> _ Title <br /> (If other than owner) . <br /> FOR DEPARTMENT USE ONLY <br /> ZAPPLICATION ACCEPTED BY DATE ...��.�� �..................:.: <br /> BUILDING PERMIT ISSUED .................. .................•---•-•--- .......DATE <br /> ADDITIONAL COMMENTS .............:......... <br /> --•-------------------------------..............................-------------------•--...----------•--- -. -----.------._ ..........................................................-----.....--•- <br /> ._.......:_.- - ----.._..- -- <br /> Final inspection by .. Date _.... -a - ----------•---- <br /> - - - ........_._.._.._ -•---•-•-•----•-•------------- <br /> _r EH 13 2h 1-68 Rov. 5K SAN JOAQUIN LOCA HEALTH DISTRICT 8/7h 3H <br /> l Th-Is iS a G49t/ 0-f awfte es 600V elf <br /> F 10d <br />