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FOR OFFICE USE, APPLICATION ICOR SANITATION PERMIT Permit No. ......... .. y................................ (complete in Trlpllcotel ' .............. .......... ........ _, . ...-Date issued b. .. This Permit Expires 1 year From Date Issued ye ................................................. r i rict it to and all the Application Is hereby made to the San Joaquinliance with CouDytOrdinarnce Nom54Si and exiuscting Rules tand Regulationsieln described. This application is made In comp ..CENSUS TRACT ............... JOB ADDRESS/LOCAT N 2. .. ........ :.. . .... ... .....................................Phone ....._....._........................ �¢..�._...... Owners Name ....................... ..._ ........ Address ....... `�, ............... City r.... ............................................. --•"•"........--•....................... ..License lPhane _-. ..,`� -•: Contractors Name .. Installation will servos est encs ayApartment House(] Commercial❑bailer Court Motel []other .........-••---......---•- _--••----••------ i Garbe a Grinder Lot Size: .......................... Number of living units:..__•_...... Number of bedrooms . --- g Peat Sandy Loam.[}•---aaY Loam Q A Water Supply: Public System and h lame _--------------.._-_- _Pea........-•---dY Character of soil to a depth of 3 feet: Sand b Slit❑ Clay ❑ ❑ Hardpan❑ Adobe❑ Fill Material ....__......if yes,type---- .--- . ---•------ + 1 IPlot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) r NEW INSTALLATIONt (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) , SEPTIC TANK . Liquid Depth ' PACKAGE TREATMENT [ 3 � � ........................................ ...i;a�. - Materia!__...-- No. Compartments _. ..� 1. capacity .i. eV�WYP6 - I Foundation . Prop. Une ............. ._� Distance to nearest: Well' """ [ ] ies1. �tngrr' of ea LEACHING LINE No. of Line ne....:. ...... Total Length ...........................ty rt*r ...._Depth Filter Materia) ........................................ - '®' Box ..I-....... Type Filter Material . __ �C -s. Distancao j nearesWell •-•--.•_•-•rt_ •,-•-•-•--•�-•-Fo LleYo-- b Q ...................... k Filled SEEPAGE PIT Depth ................ Diameter ................ Number ...... No - .�---w--- Size ............ ................ .. t�• Water Table Depth ...................................Rock -_- -......__..... I� I kFoundation Prop. Line ..:......-- --=---- Distance to nearest: Well -••••-.................................. Permit ... Date ................................. REPAIR/ADDITiON[Prov. Sanitation ....._. ..........__................. Septic Tank {Specify Requirements) ........... ........_. ..„._......_....... ._............--•--.............. .d Disposal Field (Specify Requirements ......................................• ' .................. .........................................__......-- ! -----•-••- -- ........................ .................................................-•........._._......_................................ ... .. (Draw existing and required addition on reverse sidel be I hereby certify that I have prepared this application and that thework an awouin Local District. Hone in accordancems wnet or Ilcen- ” County Ordinances, State Laws. and Rules and Regulations of the S 9 sad agents Signature certifies the following: arson In such nmannet "I-certify that in the performance of the^work for which this permit is issued, 1 shall not employ any P ; as to becomesubjectto Workman's Compensation laws of California." /� • " I Signed .... ' ' . Owner ............... .... - title .................... ............ Y (If other than owned R DEPARWA NT USE ONLY DATE .. ..•............. APPLICATION ACCEPTED 9Y . ... DATE ...- .._....-•"-..---- BUILDING PERMIT ISSUED ........... ................................ ADDITIONAL COMMENTS .................. ... 3-.... .......................................... ......""""-•------- -•-•--.........-..-...._... .._.._.. . ..........""-.................. ............. .I.......... ....I.............. .....-.... ................. .....'...... Date ...��f7.. . Y..,-........... . _ ...-. _ - --- ... Final Inspection by: --- .------ El 13 2!t 1-611 Rev- 5K SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M