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—FOR'-6F-F I_CE USE=___- Appuwrm FOR SANITATION PERMIT <br /> Permit No. <br />......................................................... (Complete In TrIpIlfaft) <br /> 'Date Issued .7:ZK::71 <br /> .................................... <br /> . ........ .............. This Permit Expires I Year Fr6m.Dat*Issued <br /> .................... - ---------- <br /> Local District for a permit to cOnstr�d and install the work herein <br /> Application Is hereby made to tho.San J0014uln <br /> described. This application Is made 1n compliance witch County Ordinance No. 549 and existing Rules and R99ulationsi <br /> .........CENSUS NSUS TRACT .......................... <br /> A ..... ............ ;7�/YY, <br /> JOB ADDRESS/LOCA -_A ., C 2 ..... atp_4 <br /> � Phone .. .......... ........................ <br /> A ........................... ........ ........ <br /> 7V" <br /> Owner's Name ....0. .......................................... <br /> ........... ........ ...........City .. . ... ... ... <br /> Address . ./sla---- <br /> ... Phone .................. <br /> ..... . ............................................L <br /> icense dk <br /> Contractor's Name <br /> installation will serves Residence Mkpartrnent House 0 Commercial oTraller Court C1 <br /> motel'[]other ----------:-1.............................. <br /> Lot Size ...........N <br /> Number of living units:_-- .... Number of,bei oorns .._Z...Garbage' Grinder ........... Z4� <br /> Private 0 <br /> Water Supply: Public system and name ......... .......t2i-�_ -----------—-------- <br /> lay 0 peat 0 Sandy Loom 0, Clay Loom 0 <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 C <br /> Hardpan 0 Adobe Fill Material ............If Yes,typo ............... ............ <br /> side. <br /> in relation to wells, buildings, etc. must be placed an reverse <br /> Mot plan, showing size of. lot, location of system available within 200 feet,)INSTALLATION: (No septic tank or seepage pit perm oval <br /> permitted if public sewer is <br /> PACKAGE TREATMENT SEPTIC TANK fe ...................... Liquid Depth ... ................. <br /> eiv;-,M- aterial....I ............... No. Compartment <br /> Capacity 1;kp..... Typee .............. <br /> ..4D......... <br /> Well ..... ....... <br /> ........ .Foundation Prop. Line <br /> Distance to nearest ...... <br /> t ­ _--d ongth .....��.*.......... <br /> EACHING LINE JLr No. of Lines ....../........ Length of 6067lihe....... Total L <br /> V Box ....... Type Filter Material Depth ....../1......;.....................) <br /> j Filter M01`9001 .4 <br /> 11 ...... Foundation ......... Property Line .2.................. <br /> Distance to nearest: We I I Filled Yes gnr' Na <br /> /................ Rock <br /> of . <br /> SEEPAGE PIT Depth ..41;V Diameter Number <br /> vi <br /> ......Rock Size .10?..Y134.................. .41 <br /> Water Table Depth ......... ............ . .... <br /> 11 . ................Foundation ........ Prop. line ... <br /> Distance to nearest: We <br /> F ! it W�l............... Date .................................. <br /> REPAIR/ADDITION tProv. Sanitation Permit ............ .................. .. <br /> I,, I I — ,,, - / , - ........ ...................o•. ......,:.^......,._..,............. <br /> Septic Tank (Specify Requirements) ..................... ....................�­................... <br /> Disoosal Filld [Specify Requirements) ... .. ........... <br /> ................. <br /> . . ........ - ..................I I............................ ................... ......................... ..... ......................... <br /> .. <br /> ........). <br /> ..........I............................... <br /> ..................................... <br /> (Draw existing and required addition on reverses <br /> d the work will be dIn accordance $01% Joaquin <br /> I hereby codify that I have piepared this!application an <br /> ationsthat of the Son Joaquin Localone with Health District. MOM owner Of 11con" <br /> County ordinances, State Laws. and Rules and Regul <br /> sod agents signature certifies the following:, <br /> 111 certify that In the performance of the work for which this permit is issued, I shall-not employ any person In such manner <br /> man's laws of talifornia."- r <br /> as to be o Pew 1.ect toy,)I'V� i 1� 1Owner <br /> . ..... ......... <br /> Title .. ....................................... ............ <br /> .... . ........ <br /> If ......... <br /> .......... <br /> By .... ----0&r than owner) <br /> FOR DEPARTMENT USE ONLY <br /> A7 I——....... DATE ....... <br /> APPLICATION ACCEPTED BY .......... ....... .C;A C.- E I ...... <br /> OAT ............... <br /> BUILDING PERMIT ISSUED ....... ........ ...... <br /> -7............ <br /> ADDITIONAL COMMENTS ...................�-- ....... ..... ..... <br /> ..... ......r_.._. <br /> Not, ......................... .......... ........... ...... <br /> ..................... ---------­.............. <br /> .......... ................. ........................ ..... ........ ...... ........1�� <br /> ..... .......I—...... ..... .... ......... ----- -- <br /> V iot............................ .............Date ...... . ...... .7.............. <br /> Final inspection by. .......___...............G.:-�.�---------------- .........................-LT-H DISTRICT 8/74 3H <br /> ER 13 2h 1-68 Rev. 514 SAN JOAQUIN LOCAL HEA <br />