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FOR OFFICE US& APPLICATION ICOR SANITATION PERM ............. �. ......... (Complete in TripocaNl Paermit No. ..,7s.�: TMs Pormit Expires I Year From Date isswe d Date!sued .. ..7� Application Is hereby made to the San Joaquin local Health District for a permit to conwtict and hwall the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulotionse JOB ADDRESSAOCATION ...r � ..��,� ,,f,!ie.-........................... ..............CEt�1S TRACT ............ ... Owner's Name . ., L. fit'°. ... . ,�..�1 SPY .......................... ..... .....Piwne ..__............................. Address ...�. ,rn.. ..........�....... .. ..,Gly �,�'�� .......... :.... ...... Contractor's Name ....../.-e_, 4 e/....................................Liosnse Installation will serve: Residence Apartment House C3 Cotnmerdol UraNer Court 13 Motel❑Other Number of living units:../..... Number of bedrooms .......Gorbope Grinder/.! .... Lot Size 1.." Water Supply: Public System and name ..._..... ....... .............................. .................................. .PrhnaMw,�. Character of soil to a depth of 3 feet: Sand b Slit Q Gay ❑ Peat[j... Sandy Loom O Clay Loam Hardpan 0 Adobe Q Fill A46terial............If yes,type........................... (Plot plan, showing size of lot, location of system In (elation to wells, buildings, ek. must be placed on revorso slde l NEW INSTALLATION: (No septic tank or seepage pit permitted N puWk sower Is available within 200 feet,) PACKAGE TREATMENT 17 SEPTIC TANK{ l Size................................................ liquid Depth ., . ........... . ..d Capacity .................... Type ... Il roe............. .... No Comte ............ Distance to nearest: Well ........ ... ....... ......Foundation ......................Prop.Line............... J LEACHING LINE ( j No. of Lines ........................ Length of each Iine............................ Total Length ............................ 'D' Box ....... Type Filter Material ..................Depth .Filter Material ......................................»... Z Distance to nearest: Well ........................ Foundation ........................ Property line ........................ SEEPAGE GE PIT ( l Depth . 01cowier ................ plumber ......... . •--•- •-------• Rode Filled Yes Q No Cj:V Water Table Depth ...... ........................................Rock Size ... ..................... Distance to nearest: Well ........................................Foundation ................ Prop. tine ............... REPAIR/ADDITION(Prov. Sanitation Permit# ... .... �DoN ......................... Septic Tank (Specify Ditposol Field. t$pocify Requirements) --•-•••... ......... ........ ..........-- ..... .........•._........ ............._... ..................... -Draw existing and required addition on reverse I hereby certify that I have prepared this application and that the work wiN lege done ;a accordance with San ,l"Wo County Ordinances, State Laws, and Rules and Regulations of the Seta Joaquin Local Heave District. Name waver or Nan- 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 person in such momm as to become subject to Workman's Compensation laws of Califomia." Signed • ••--• ............................................ Owner By .... c:� ' .........._ Title .... other than owner) R DE AR?HENT USE ONLY APPLICATION ACCEPTED BY ..................... ..................:. ......_.:.. DATE .. . (....... ...::_.. BUILDINGPERMIT ISSUED ----- .........................................................................••------..............DATE --....-.................................... ADDITIONAL COMMENTS ..... ,............:.......:._................_ Fy. .. ---------•-••. ....... Final ins ection T . .. .� -- - -._. ... .......................Date . �? EH 13 24 1-613 'hev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3m G5