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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT permit No 73= --. ---------------------------- --- (Complete in Triplicate) 3 --)3 Date issue ------ This Permit Expires 1 Year From Date Issued In - - - s - - -- - ----- ----- •p wa l const and install the work ere Application is hereby made to ffie an Joaquin r;ct or-i�-js . Rules and Regulations6 n compliance County Ord' ac� No. 5A9 and exisfiirlg, described. This application is mad CENt l TRACT .... - ----- .0 _ j JOB ADD ESS/LOCATION - lV'E- ice �7 I �d/C "C' 11f� e ----'Phone/ -!_ ._-��----- owner's Name _�iG- city �/�Q�A---- n _ - c' � - = hon . x.Ty4_-.. ,� _ _ Ci Address --- - - ' •-�=- --�---- - - ----.License �--= - r. Contractors Name �I e � Commercial []Trailer Court � i ni Installation will serve: Residence [' Aparfi ent House's Motel ❑Other l-~-7",� h,"A'r- f f I i >- e �0 r9�' k Number of living units:-J------- Number of bedrooms -------Garbage Grinder `_----- Lot Size-_ -- --------Pri t - Private Public System and name ----------- ------------------------------------------------- ---------------------•------------- ----- -T w Water Supply: y „i -- Clay loam [ Peat� 'Sandy-Loam �[ , It ;— Character of soil to a depth of 3 feet: , Sand'[]---Silt❑ Clay ❑--;1 t.� s - - --------- Hardpan ❑ Adobe.I] Fill Mate real ___----- --- if Yes,type ... . - N lot location of system in relation to wells,,buildings, etc. must I be placed on reverse side.) 1,, ' (Plot plan, showing size of V. it ermitted if publl seXr is ava;la�e w;�hi# 200 feet,) /l 1 SEPT TANK ge p p 01 - liquid Depth � ------- -------- ------------- Size? ----------- { .g NEW INSTALLATION: (No septic an �� PACKAGE TREATMENT l , 1'� � No. Comparfiments ---- r = capaci v _ �� yp = '. Matena � ---- -;----�-=r�-Foundation�� `,'��:--- Prop. Line.��-----.•--•--- �I Distance o near : Well -. ---- ..s � Total Lengt�T'-�'-�--•-•--•-----•-- } ,,/ No. of Lines - ------------------ Length of each line-----<r -------------- . -- -- j LEACHING LINE [+7 D' 13ox F^S_. Type Filter Material l a� ------Depth Filter fMateriai ----- .. -----....I --grope-rty Line. .��-- No i --_-. Foundation :;:;7y I Distance to nearest: Well 7_ ----- . Number -----------------�- -- -� -- Rock Filled Yes � Depth ------- ----- ---- Diameter. _,:----------- L...�,,....� ► SEEPAGE PIT [ l p i------------- Water Table Depth ------------- -----•----- Rock Size ---_-� ------ . �Prop. Line ---------------------- ,--Foundation --------I - Distance to nearest: Well -------------------------------- ) Dat�------------------ - REPAIRfADDITION(Prev. Sanitation Permit# -------- ------------- ----------- --------------------------- -------- -- . Septic Tank (Specify Requirements) ------------------------------------------------ --------------- i------------------ isposal Field (Specify Requirements) .� ---------------€------------------ --- - ------I--•------------------ - r _-- ---- _ �� . - --� -- -- a r,. - _ ------ ------- (Draw existing and required addition on reverse si e 1 hereby certify that I have prepared this application and thatthe San the woJoaquin Lac IIIHealth.)D stri tnHomeie 1towner or I cenh Son � 1 County Ordinances, State Laws, and Rule and Regulations o [ sed agents signature certifies the following: 10 any person in such manner "1 certify that in the performance of.the work for which this permit is issued, I shall not emp Y i as to become subject to Workman's Compensation laws of California." ! Owner Signed = r /oxw— ------------------ G��ul� --------------- Title - 13 b \ ,� (If other than owner FOR DEPARTMENT USE ONLY �6 • _ DATE - ---��- --------- : .- APPLI' TION ACCEPTED BY ----` `-1t'-0'------------------------ ----- ----- ---- ----DATE -------------- `':A- - BUILDING PERMIT ISSUED ------- --------- ----------------------------- - " -------- `. ADDITIONAL COMMENTS ------ --- -- -------- w— - ---------------- --- -- - -------------- -- -a---- - ----- -- -- - --- -- Date - Final -- ----- --- -- ------ - SAN JOAQUIN LOCAL HEALTH DISTRICT u 0 1-'AR Rev. 5M -