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�9^2 FOR OFFICE USE '' APPLICATION FOR SANITATION PERMIT Permit No: -.--- (Complete in Triplicate) ---------- -_--- - Date issued--l----q This Perrnst Expires l Year From Date Issue ermit to construct and install the work here-in ----------------------------- - - - - -, - tions: � Rules ant,Regu the Ordinance No. 549 and existing i Application is hereby made. adean compliann Joaquin ce witlh CouDytrict or a P �,,��fp� ,- S TRACT described. This app l scat ( ENSU ,53s errr = -y�i.��. _. N .� � -� . - --�-- -- -- � --- ----Phone�- - LOCATIO JOB ADDRESS/LOC N/ _ = ------------------------------------------ c. _- ._ 1 cit 1�Y------- Owner r� �{ 's Name C =.; ----•-- Y !'-- •� _ � �_- -- ------ --�-- License # _ �! hone P -- i Address .-- --- Contractor's Name -- -- --' + Trailer Court `❑ - Commercial . Residence�`Apartment Hbus�❑ I installation will serve: / -J— ------------------- Motel ❑other , 1 �� _.Q- � Lot Size - y---- - J � ""Garbage Grinder ft—I Private ®— Number of living units:---f_------ Number of be --- - ----- -------- ------------- ----- -- j --- -------- ❑ Clay Loam Water Supply: Public System and name ---nd Peat❑ Sandy Loam Slit❑ Clay ❑ _ ___ _ _ f soil to a depth of 3 feet: Sand`� es,typ Character oe � Hardpan ❑ Adobe'[] Fill Material - . �--- If Y r etc. must be placed on reverse side.) I it ermined if public sewer is available within Zoo'get,) { (Plot plan, showing size of lot, location of system in tela#ion to wells, buildings, � 4 Z� - ` NEW INSTALLATION: (No septic tank or seepa p permitted Liquid Depth---- I X p tl_. q_.---� Size _-/- -� SEPTIC TANK[ _.P---- - '� r ortments ---�-- PACKAGE TREATMENT [ 3 — -- _ w i Material_C.� °' omp i Type �. i ,P Line Capacite � WFoundation 1 . ta iCpnearest. _P § I Total l SLength of each line.-.---, � - I! ---- ` „s , Material_ . -, ----- --•---- { NIooj L - - ir LEACHIN 'INE : l MCI /_ ��NCufm<be-rDs e-pth Filter D' ox/ � terial U � PropyLineBJ -- TYpe Fiter No ❑We11�--- ---- Foundation ---- ce.to-nearestrRock Flied Yes ❑ . Distan Depth Diameter SEEPPIT t,� ------- -- -- -------•Rock Size i Water Table Depth ------y----------- - - - - '�,� � -- - Prop. Line ----------------------p i Foundation ---(- I Distance to nearest: Well--------------------------------------- �� ----------- it ` Date ` l REPAIR/ADDITION(Prev. Sanitation Perm # --- -------------I-----_w-_:-- -------------------------- Septic To (Specify Requirements) --------- -11�- ---- I_------------- ----- Disposal,17 (Specify Requirements ---- t -------- -------- ).3 ---- ----------------- = { 1•� _ _- _____ ..� _ .___-._ __� _ __._ _ - - e side; x i ; ------ (Draw existing and required addition on revers i lication and''-that the work will be Localone in Health D strct}nce Hotiietowner or I'�gcen I hereby certify that-1-have prepared this app • y� j County ordinances,,.Stat Laws, and Rules and Regulations oftheSan Joaquin f t an arson in such manner sed agents signature certifies.the following: i "1 certify that :n the.,perFormance of th;work-for law• hthis -permit 1$jJLssued, I shall not employ Y`1� r as to become subject to Workman s Compensation Owner ; ------ --- r x -- --- i Signed Title ----- ----- (if other than owner) -- .DEPARTMENT-USE-ONLY - 2. ; t"T tv I �-' + _ _.. DATE r E� _~:r` ------------ - -- --- -,DATE -- w ----= APPLICATION ACCEPTED ------- r___.�.,--------_ - --- - BUILDING• PEIZM1T-ISSUED- =___7 ADDITIONAL COMMENTS ----- ----- ------------•-------------------------------- __ �.. ,___ _ - ---- Final Inspect' . SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 - 1-'68 Rev. 5M