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FOR OFFICE 7 USE: APPLICATION FOR SANITATION PERMIT Permit Noky-�7RO_ ----------------------- --- ----- ---- [Complete in Triplicate) # I Date issued ------------------------------ --- ----------- This Permit Expires i'Year From Date issued ----------------------- -------------- -------------------- tall the work herein Joaquin Local Health District permit to construct and ins Application is hereby made to the Son J, d existing Rules and Regulations: ice with County OrdWarnce'. fo_ 5A9 n, described. This application is made in compliance -------------I----------- ------CENSUS TRACT - ------------ - - --------------- JOB ADDRESS/LOCATIO / , --------------- Phone ------------------------------------ ------------- Owne ' Owner's Name ----- _a�z----------- z� W-__1 _',--------------------------------------------- Af - ------ - ---------—___ I--------- city # -------------------- ----------------- Address --------------------- -- -- ----- License Phone ------------ Contractor's Name ---------RDAV---------- -- -- - -- -- -------------- ci I Trailer Court 0 Installation will serve: Residence n partment House-F� Commer a Motel ---------- []Other ---------------------------------- Y ----------- Number of living units:_______--__ Number of bedrooms -__(------Garbage Grinder Lot Size'-Z------- ---- --------------------Private Water Supply: Public System and name --------------------------------------------------------- y ClaLocim .0 Character of soil to a depth of 3 feet: Sand 0 F1 Sandy Loam El Silt 0 Clay I Peat❑ I . --- JI� - I --- -------- If yes,type ---------------------------- Hardpan ❑ Adobe Fill Materia i . — buildings, etc. must be placed on reverse side.) (plot plan, showing size of lot, location of system in relation to wells, ewer'Is available within 200 feet,) NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer PACKAGE TREATMENT [ ] SEPTIC TANK Size-----------------------`--- ------------------ Liquid Depth -------------------- Material---------------------- No. Compartments ------------- Capacity -------------------- Type -------------------- Distance to nearest: Well ------------------- ----------------"Foundation ---------------------- Prop. Line ----------------------- -------- ----------- Length of each line----------------- ..... Total Length ----------- -------------- LEACHING LINE No. of Lines Depth Filter Material ---------------'--------I--------- 'D' Box ------------ Type Filter "<Z) to nearest-iWeil -----------z�--------- --.-7=,Property Line. ---------------------A— Distance Yes E] No Rock Filled SEEPAGE PIT Depth ------------ ------- Diameter ------------------Num[ber ---------------------------- i Water Table Depth ------------------------------------------ -----Rock Size --------- Prop. Distance-t6'nearest: Well ------------------ ----------------------Foundation -,'-=---------------'-- rop. Line ...I---------------- I- Date --------- !-'-----------------=-=- REPAIR/ADDITION(Prev. Sanitation Permit i# -------------------------------------------- 1 j.; ----------- -------------- ----------- --------�p ------ .1------- Septic Tank (Specify Requirements) -------------------------------- - ----- ------------------- ------ --------------- --------------- Disposal Field (Specify Requirements). ---------- ---------- ---------------------------------------------------- ------------------------------------------ ---------------------------- ------------------------------------------ ------------------------------------ - ---------- --- -- ---- -- -------------------------------------------------------------- --------------------------------- (Draw existing and required addition on reverse side) the work will be done in accordance with Son Joaquin I hereby certify that I have prepared this application and that Joaquin Local Health District. Home owner or licen- sed Ordinances, State Laws, and Rules and Regulations Of the Son sed agents signature certifies the following: k for which this permit is issued, shall not employ any person in such manner -I certify that in the performance of the wor laws as to become subject to Workman's Compensation I '.s of California." Signed ------------ ---------------- ------- ----------------- I---------------------------- Owner By ------------ ------------------- --&01 '-- 1,------------ ----I-------------------- Title ----------------------- a. (if other r) 11 FOR DEPARTMENT USE ONLY DATE J ------------------ -- --------------------------------------------------- APPLICATION ACCEPTED BY ----- - ------ --------- ------- t ------------------------------------------- BUILDING PERMIT ISSUED ---------------- ------------ ------------------- __-------- -------- -------------------------------- ------- ------------- --------------------- ---- ------ ADDITIONALCOMMENTS --------------------------------------- ---------------------------------------------------- ------------------------ ---------- ------ ---------------------------- -------------------- ----------------- ------------------------------------------------- ------ --- ---------------------- -------- ----------------------- ---------------------------------------------------------------- ------------- -- --------------------- & --------- ------------------- ----------------------------------------------- --VAX---------------------------------------- -----------Date ---------- -------- Final Inspection by- --------------------- ---------- - ---------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev-5M.