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J ... .. FOR OFFICE U,_ APPLICATION FOR SANITATION PERMIT Permit No: �------- ------------------------ ,^.,.,.(Comple e in Triplicate) - -- --------- Date Issued This Permit Expires 1 Year From Date issue and rict for a p Application is hereby made-to the Joaquin L ec wi h CounHealth ty Nom549 an existing it to Rules tand Regulat onsrein i..• ` `Y „ ibed. This application is made in compliant t I _ �:. TRACT desc� f� � � -- --- --- -CENSUS T ----------------- JOB 1ADDRESSjLOCAT140 -�- --- -- ------- -------- - ---phone - Owner's Name .- /3 -- --------------- --- -- tY G - ani Address' - -- �, - --- - - 4. ._ ',�%-f��-�e97Z --------------------- License #146 I Contractor's Name _ -_ Instal ion will serve: ResidenceApartment House Commercial :❑Trailer Court l❑ Motel ❑Other ------------------------------------ ------- � s - Lot Size ! ._ Number of living units: -.�: -- Number-of bedrooms -14----- Grinder� --- } p I Private - Water Su ply:`.Public System and name ----------------- - - I Cla Loam.6 ' Silt Clay ❑ Peat❑ Sandy Loam ❑ 0 Character of soil to a depth of 3 feet: Sand'❑ ❑ p Adobe Fill Material ------------ If yes,type -------------R-------------# Hardpan ❑ y� •ter 1 y r (Plotlplan,.showing size of lot,.'location of system in relation to wells, buildings, etc. Mu '}be planed on reverse side.) \ I I T �t ermined if public s wet is available within 200,feet,) r NEW`1NSTALLATION: tNo septic tank or seepage p' p P. r° �. // `_____- Liquid Depth - Size-_ , L - ------ [ ] tSEI�TIC4TANK; a.�. i 04 t .��_ .. i _ Material_�/-d--,!- No. Compa ments ---- �... t PACKAGE TREATMENT Capacity iS1� -__-- Type i �t i 1 r_ Foundation•A99---------- Prop.•Line �-_ --x` , I Distance to pea�estl Well _----_ --- --� i ,� Length of each'iine- Total Lerigth ��4 ---•- , LEACHING LINE No. of Lines -- -- --- --- ' r1T e Filter Material % fi�diepth Filter Material t D' Box - - -- - Type Line -_ 2 •-------------- Distant to nearest: Well ---- Foundation - � Prop" i ,Ro&-Filjed Yes ❑ No ❑ SEEPAG�PIT [ ] Depth --------- Diameter ---------------- Number ------------- ------ Water Table Depth Rock Siie _-------- # = Line ------------•--------- -.-• Distance to nearest: Well ------ ---------------------------fl Foundation -------_-;------------------------ Date -------------- ------L-A------f.PF&P. I REPAIR/ADDITION{Prey. Sanitation Permit# --------------- # ' ------------- Spic Tank (Specify Requirements) -------------------- ------------------------------------------ ------- -----------------T----------------------:--- = -U -- ------------- Disposal Field (Specify Requirennfst __--------- _=4 Y--k- ----------------- _ 1 wl_ -------- ------- • ------------------------------------------------------------------- ---------"-- __"-___ _-, _ -'----___- . (Draw existing and required addition@on reverse side) I hereby certify},that I have prepared this application and that the work will�be done iri accordance withl`Sgn Joaquin County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home oner or licen- -sed agents sig detu re certifies the following: person i� such manner "I certify that in yhe-fPtrformanee,of-the work for whiFh this permit is issued, I shall not employ any as to become subject to Work an's Compensation la R s of California." Signed --- ----------- ---- ----.-- Owner --- �>y .' � I , ---- Title --------�Y`- � ----------------------- - I (If of t an owner) I ie FOR .DEPARTMENT USE,QNLY .� _, Sg, ----- ------- ------------- DATE --$- APPLICATION-`ACCEPTED BY - -N V - -------------DATE ------------------------------------------ BUILDING PERMIT ISSUED t `' -------------- --------•------------------------- ------- --------------- ADDITIONAL COMMENTS =",. -------------------------- 7 = = ------------------- ----- # ------------- ------ '--------------- -- ----------------- - -------------- ------------------------------------ ----------------------------- = ------------------ ----- -- --- ---- ----------- t Iii° --------- ---------------------------------- ZN- Date I ;r ''�----------- Final ;Inspection by; ' �x - ' -------------------------------- C/ JOAQUIN LOCAL HEALTH DISTRICT E. H. 9� �1-'6B Rev. 5M. `t♦