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FOR OFFICE USE: APPLICATION FOR SANITATION PERMITAle <br /> Permit No:'.-�-` - a------- <br /> ------ . <br /> ------------------ (Complete in Tri licatel <br /> p Date issued _-�--e� r-� <br /> ------------ - <br /> --------------------- <br /> ------ <br /> This Permit Expires i Year From Date issued <br /> to construct and install <br /> lthe work herein <br /> Application is hereby made to the Sancompliance eLocal withalth County trict for a permit <br /> OrHance No. 549 and ex st ng Rules and Regulations-. <br /> described. This application" n Camis made p <br /> CENSUS TRACT <br /> -------------------------- <br /> -- , <br /> JOB ADDRESS/LOCATIO rZ ¢ <br /> Phone -------------- <br /> �� = <br />: Owner's Name -- 7 <br /> ,�► City f <br /> Address -- ------ ------ --' - ------ <br /> �,�,,/ "_.License # r� <br /> Phone <br /> Contractor's Name __._ ____6��{__�!?�i-- -- ��- - -" <br /> Installation will serve: ResidenceKApartment House'❑ Commercial:❑Trailer tart <br /> Motel ❑Other ------------------------------------------ <br /> Lot Size ___-"" --- - <br /> i Number of living units:-." ------- Number of bedrooms __�_____Garbage Grinder ------------ <br /> - Private <br /> ---------------------------- ---. <br /> Water Supply: Public System and name ----------------------- ------------- - ❑---------------------------.---------- <br /> Clay Loam <br /> Character of soil to a depth of 3 feet. Sand'❑ Silt❑ Clay ❑ Peat Sandy Loam ❑ Y' <br /> ---------------------------- <br /> (Plot <br /> ---- -------- <br /> ] Hardpan ❑ Adobe� Fill Material ------------ If yes,type ----- ------ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) oa <br /> Size------ ---------------------- Liquid Depth <br /> � SEPTIC TANK [ j ------------'-""- - <br /> PACKAGE TREATMENT <br /> Capacity ------------- ------ Type -------------------- Material--------- ------------ No. Compartments ------- -------.....-- <br /> ��;,Iri <br /> Distance to nearest: Well Foundation -� Prop. Line -- <br /> ------------------- --------•—-------- �. <br /> (, Total Length -_ <br /> --- ----•- <br /> No, of Lines __-_-" - - ----- -- Length of ach line{ ] - JPr <br /> 1 <br /> p' Box --- Type Filter Material r 'p ----Depth Filter Material ----.-------- <br /> i �rs`�SrN y r � ___ Property Line. - <br /> to nearest: Well __-, Z ______""-_ Foundation ------- <br /> i Diameter . -.---- Number -------1-------------- Rock led YesX No------------ <br /> Distance <br /> SEEPAGE PIT [ ] Depth ---,Z <br /> — Water Table Depth ------. ----—--------------------Rock Size -- ` �-- <br /> sr _Foundation - C2 .--•---- Prop. Line -- •--"---"•--• <br /> i Distance to nearest: Well ----�L?�----------------------- �- <br /> ----------------------- Date ----------------------------------) <br /> REPAIR/ADDITION(Prev. Sanitation Permit# "-------------- ----- ---------------­---------- <br /> - <br /> Septic Tank (Specify Requirements) ------------------------------ <br /> Disposal Field J§pecify Req uir ents) <br /> /- �` ---- <br /> X_ ._ <br /> ---------------------- --------------------------------------------------------------------------------------------------------- <br /> (Draw existing and required addition on reverse side) <br /> hat the work will be <br /> ne in <br /> ace <br /> h Son Joaquin <br /> 1 hereby certify that I have prep nd Rules and'Regulallonsed this applcation andtof the San Joaquin LocaloHeal h District.nHometawner or 1 cen <br /> County Ordinances, State Laws, a <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to becomes to Wor an's Compe tion laws of California." <br /> -" Owner <br /> Signed - <br /> Title ----------------- -- <br /> ---------------- -- <br /> ------ <br /> (If other than o er) <br /> POR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .__ _ DATE ___- ------��=��----------------- <br /> - - - - - --- ----------------------- ---- -------- --------- -------� DATE - ---------------------------------------- <br /> BUILDING <br /> -------- ------- -------- ------------ <br /> BUILDING PERMIT ISSUED -__f-- --- -- ---- - ------- ----- <br /> ----------------------------------- ------ <br /> ADDITIONAL COMMENTS --- - - --- ---------- ----------------------------------------- --- ----- - <br /> --- ------ - ----------------------------- <br /> -------------------------------------------- -- --- <br /> Date---------In -- ------- --- ----- T 773— <br /> Final Ins ection b � - - ------------------------------------- -- ----- ------- ----- " <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Re M _- <br />