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FOR OFFICE USE: APPLICATIOW FOR SANITATION PERMIT L/ Permit No: .-7�7 T •. ----------------------- L 12mm i to in Triplicate) -------- -------------------------- ------- Date issued _ �'7_• ,T a Fx 1 Year-From-Date Issued ""`"" ; -..�pi rict a per it to construct e-work herein Application is hereby made to the Joaquin Pian coal mpliance Counealth DtytOrdinarn a Nom549 and existing R'ulestand hRegulati ns: described. This application , � �r� - �ENSUS TRACT JOB ADDRESS/LOCATIONdZr61(-L--50--- - -Phone Owner's Name __._W_l_ --C4 ,; ,a •------ ----------------- ----- -- - ---.- -------------------------------- - City'- r_'-�-------------=- Address - ' ----6-'Phone �Sz-� l �® = ---License #a��*�3�-- � Contractor's Name -- _. T ___.t o- -�--�`"------------ --- - ------------ ---- A Installation will serve: Residence{ partment House Commercial :❑Trailer Court Motel ❑Other _._ - ___-Garbage Grinder 14-.- Lot Size _460 Number of living units:---- -- Number of bedro -------Private ❑ Water Supply: Public System and name _--�_________ _______ -----(e"-- --- ---- P of soil to a depth of 3 feet: Sand'E FSilt 0 -c-lay- •- ..-.Peat❑t .Sandy.Loam ❑ Clay Loam ❑ Hardpan ❑ Adobe' ill Material%1/E'=- If yes, type ___-_.__._ _ __ {Phot plan, showing size of loft, location of system in relation to wells, buildings, etc. must be placed on reverse side.) NEW INSTALLATION: (No septic tank or-seepage pit permitted if public sewerais available within 200 feet,) ��2 . _ --- Liquid'Depth---- ---------- PACKAGE TREATMENT [ SEPTIC TANK' ize--_�� ---- PACKAGE t /� No. Com artments _ -------: Capacity ----�a"�-P�`�-- TYP------- Material P J Distance to nearest: Well -----------Foundation --�. -------- Prop. Line -__-`-�- •---- if1 11 LEACHING LINE [ No. of Lines _- 1 _ Length of each line-��-- -�- --- �- Total• .Length ;� •-----•- i _De Depth' Filter Materia[ __-- /�� 'D' Box _ronearest: Type Filter Material ��----- P , -r ------�- } 1� Foundation _ ----------- Property Line 5-----------•-------•-- Distance Well�r� elm°'? Diameter �- Rock Filled Yes [,�/No ] ��--- Number SEEPAGE PIT [,� Depth ------ ---- - f J 4. /' 9_6 Water Table Depth Rock Size _!�2 k -------------- s. t _..Foundation�-_�--- «----- Prop. Line ---------...... Distance to'nearest: Well _-____. ------- ` --- Date ----=------------------------ "REPAIR/ADDITION(Prev. Sanitation Permit# ------------------- " �!- Septic Tank (Specify Requirements) ___________________.- _--.--- --------------------------------------- - --------------------------------- --------------- -------------- Field (Specify Requirements} ;------------------------------ Disposal -------------------------------------- (Draw e----------------------------------------- stin ---- ---- --- ----------------------------- ------- ------------------------ ---- --�--��- - g and required addition on reverse side) I hereby certify that I have prepared this application and that the work will be done m accordance with San Joaquin and Regulations of the San Joaquin Local Health District. Home owner County Ordinances, State Laws, and Rules or licen- sed agents signature certifies the following: R ' "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California- Signed f ` --------------- Own .� -------------------- y Title (If of r han owner) it § S +s FOR DEPARTMENT USE ONLY -------------------- --- ---- -- - APPLICATION ACCEPTED BY .__ j' BUILDING PERMIT ISSUED ---------------------------------------------------------- -------- .DATE------------------------------------- -------- - ----•-------•-------•-- .._ ---------------- ! ADDITIONAL COMMENTS -------------------------- - --------- --------- a = /� a .___ _-------________________ _______-_____-_____- ___-___._ ________ ----- -------i -____-___.4__. __________________ ._______ __.-- --------& - ____ __ _ _ _ _(-12 ________-____--__ _ ---- •:, ! Fff1 _ _ _ _ _ ______ --- ------------ Date ----------- - Final Inspection by: -_-.- i t SAN JOAQUIN LOCAL HEALTH DISTRICT C F_ H- 9 •"1-'68 Rev. 5M