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FOR--OFFICE USE. APPLICATION ICOR SANITATION PERMIT --- Permit No. (Complete in Triplicate) .................................. ....... This Permit Expires I Year_Frarn 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 in compliance with County Ordinance No. 549 and existing Rules and Regulations: JOB ADDRESS/LOCATION ` � .................................................. CENSUS TRACT ..-.............:..............7 n � Owner's N e H . G RCC'!V.._ I.�)..............I.........._ I....................... .......Phone ../_ /'�"' J�6S/ --•------- Address - 6.3C3�f �� f C/g� � _..:City ..1 ! �''� ' i ----------- ---------------- ------------------------------------- . Contractor's Name R�a �' __...License ` ... Phone I y 1, 9 ?3~� �`f Installation will serve: Residence❑Apartment House 0 Commercial❑Trailer Court 0 4 motel ❑Other �S .RWeli I ........................ �C ee5 ' Number of living units------------- Number of bedrooms ..._-_--Garbage Grinder ............ Lot Size ..........•................................. Water Supply: Public System and name .............. ....................Private Character of soil to a depth of 3 feet: Sand I@ Silt❑ Clay a Peat❑ Sandy Loam 0 Clay Loam ❑ Hardpan ❑ Adobe 0 Fill Material ............ If yes,type - [Plot plan, showing size of lot; location of system in relation tor wells, buildings, etc. must be placed on reverse side.) �J NEW INSTALLATION: (No septic tank or seepage pit ,permitted If public sewer is available within 200 feet,) PACKAGE TREATMENT [ ] SEPTIC LANK� ] ------- Liquid Depth ..............---•--...... y. Capacity yp CP�?F�T p ............. No. Compartments ' --�---- -•-- � e .-•-------...�...... Material.. -•-•-- r _.------••----._....._ F tsU fi=r°# t2 Pr=�`'1' Distance to nearest: Well � � ---..�Q_�.......................Founda�fn ----��-----------. Prop. Line -----®o -•--...... LEACHING LINT~ es .- _-1------------- Length of each line....---9-_...--___------- Total Length .......7............._... C 1 t ` o. o Lin 'D' Box -.X----.. Type Filter Material ........Depth .Filter Material .___.f .................................. Distance.to nearest: Wel! ----/-•------.......... Foundation --------------•------•-- Property Line ....�?�'5.1............... SEEPAGE PIT [ ) Depth .................... Diameter ................ Number ---------------------------- Rock filled Yes ❑ No 0 Water Table Depth - - ..Rock Size ................................ Ile Distance to nearest. Well ..foundation ....... ............ prop. Line ------ ----.-_.------- REPAIR/ADDITION(Prev.-Sanitation,Permit* ----"--"`.....'"-.`._'""------------- Date .................... ..............) Septic Tank (Spetify,Requirements) ..................i. ..............-------=----•---------------...-------••---..._.._..._._..... ..... ......_....._...... •� Disposal Field (Specify-Requirements) ----y - -............................................. .................. ........ ----------------------------------------------- ------------•-•....... ----------------• -- ----------- -•--------..............-••-•----.....I........••....---•--•....... --•--- h '(Drdw existing f7nd reguired'tiddition on reverse side) 1 hereby certify that ["have prepared this application and that the work will be done in accordance with San Joaquin County Ordinances, State lows, and Rules and Regulations of the San Joaquin Local Health,District. Hance owner or licen. sed agents signature certifies the following: "I certify that in the performance of the work for'which this permit Is issued, l shall not employ any person In such manner as to become subiect to Workman's Compensation laws of California." Signed i Owner Gom . BY ----- ---------------------•--•-•----------- ---------------- --------------------------- Title (If other than'owner) OR EPAR. ENT U E ONLY _ APPLICATION ACCEPTED BY ---- - DATE .._._-.." _1'7--•------____-: BUILDING PERMIT ISSUED .•---------------------------- - - 7/ .-----------DATE --•- ----------•------..-.----------------. ADDITIONAL COMMENTS ---- ..------ --------------------------------------- .-... . . . . .................................................. ------------ ------------- - -- Final ins--ectiari.b .......... ... ---------...--. ---•�SAN - •• - --•-,--.....-..-... ...--..-...-....-------'....... ..................... --------------- Final .-._.__.--._... -.- . ---Date ...... U, .. EH 13 24 1-68 Rev.' 94AQUIN LOCAL HEALTH DISTRICT 8/7h 3M