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FQP,,OFFICE USE: APPLICATION-FOR SANITATION PERMIT Permit No: _ =-- ------------------ (Complete in Triplicate) "--"" - Date Issued -"�-=- --"-7 - ------ This Permit Expires 1 Year From Date issued Pp a permit to con Application is hereby made to the San Joaq ; oWi�l?Co District ance No. 549 and existing Rules struct and tand hRegulat ons. 1 application is made in compliance described. This app - J'" �I�M!/� NSUS TRACT --------------•---- ------ ��5�l ------ ---- ------ JOS ADDRESS/LOCATION - � --- --Phone�-- ��/�------ ' =�T� 5----------------- I., Owner's Name ------- ----------------- _ L- ------ City ----" i;- � t�J_/_/✓ F -------------------•----- Address ---------------X-"- ?!t�-------------- License # -------- ------- ---- ... -- Phone -- ------ -------------•------ Contractor's Name -___-. -- - --- ----------------------•--- ---------- Installation will serve: Residence❑Apartment House'❑ Commercial :❑Trailer Court i❑ Motelthey -------------------------------------------- �— Garbage Grinder __._-___.__- Lot Size J --- --- ----- --- Number of living units------------- Number of bedrooms 4 ------private ❑ �. -- -"`'------------------------------------------ Water Supply: Public System an name -------------------------------- ❑ Clay Loam Character of sail to a depth of 3 feet: Sand'❑ Silt{] Clay ❑ Peat❑ Sandy Loam Hardpan ❑ Adobe ❑ Fill Material ------ if yes,type ---------- :i . buildings, etc. must be placed on reverse side.) oQ jPlot plan, yshowing size of-lot, location of system in relation to,wells, 1 i NEW INSTALLATION: (No.septic tank or seepage pit permitted -ifspublic sewer is available within 20d feet,) �. Size 0 - Liquid Depth ------ - PACKAGE TREATMENT f ]'�`SEPTIC TANK [ 2 Type materia (,aivG2 No. Compartments -----------• Capacrty.l a YP A Distance to nearest: Well ___ _D---7�.--` :______Foundation /41-------------- Prop. Line -------------------- yp ------ Total Length ---- f _ Length of each;I' e_ --C,/ LEACHVNG LINE No. of Lines-- - ------ /��f p k � ' )6�B th Filter Material D' Box _-� ---- TYPe Filter Materia �-=-: P �-� �f---------- Property Line ---�---._...---- i Foundation Distance to nearest: Well ----- ------------------ No �] _ Depth _ Diameter ----- -;------ -- Number ---- ------------------------ Rock Filled Yes ❑ Water Table Depth ------ - --------------• ,�+--An�--{ Rock Size SEEPAGE SPIT [ }' P -------- , a i Foundation -------------------- Prop. Line __..------------------ --- ----• -------- Distance to nearest: We -----------=------ .. - t 4''c = - - Date ----------------------------------1 REPAIR/ADDITION'IPrev. Sanitation Permit# -------------------- Septic Tank (Specify Requirements} _._-______--_.____.- ----------------------------------------------- - ---------- - ----------- - ------------------------------- - Disposal Field (Specify Requirements f ___________ ___________________ F { __________ ______________________________________________________µ____.________-___-___-_______--______-.._____---_-_.__---._____-_______-______._______.___ 1 jDraw existing and required addition on reverse side) ne in accordance %vi I hereby certify that I have prepared this application sthat the w of the San Joaquin Local ork will be oHealth District. Home towSner or l cen County Ordinances, State Lqi i ii-and Rules and sed agents signature certifies the following: person in such manner "I certify that in the performance,of the work for which this permit is issued, ! shall not employ any as to beco .e subject to Workman's Compensatiqn laws of California." Owner Signed :.. -- ------ Title - -------- -- --- ------- - --- Y _____ ________ _ _ _ - ---- --- ----- ----------------- ------- -- -------- (lf other than owner) l FQR DEPARTMENT USE ONLY p DATE ------ - -'�=--f -7/------------- APPLICATION ACCEPTED BY ----_ lam._ DATE ----------- I3UILDING PERMIT ISSUED - ... r -- --- _ -- .--- . . -------------- �..�_ .,_ ADDITIONAL-COMMENTS-_ T._-:-'_= -------------------------------- --.,`------ - - ---------- ----•-- �, ---- ------` "---------------------------------------------------------------- ------------------------ ----------------------------------- - ------------r,- -- ----'-'' 1 r ��i: ------------------------------- ----------------- ---------- --� - ---- ------------------ -----Date Final lnspection b ---------------------------- SAN " SAN JOAQUIN LOCAL HEALTH DISTRICT G� r 4 1-'68 Rev. 5M