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SANITATION PERMIT <br /> FOR OFFICE USE, APPLICATION FOR S Permit No. <br /> ------/,W------------- (Complete in Triplicate) Date issued <br /> le ..-5W <br /> FOR OFFICE U <br /> Issued <br /> —------------ Year From Date <br /> This Permit Expires <br />----------------------------------------- Local Health District for a permit to construct and install the work herein <br /> made to the San joaclui, LC County Ordinance No. 549 and existing Rules and Regulationst <br /> Application is hereby ation Is made in compliance with 0, <br /> described. This aPPlic ------CENSUS TRACT -------------------------- <br /> JOB A( ........ ---------phone 1- -------------------------------------r-----------------6---------- --- <br /> )DRESS/LOCATION - ---------R—I , <br /> Owner's Name _D_fZJ_6JL1_Vi I— - el r city ------------------------------------------------------------ <br /> --- <br /> - ------ ------------------------------ --- Phone -- --------------------------- <br /> AddreAddress -------------3_3 -------/V <br /> s --------------------------------License # ---------:---------0 <br /> Contractor's Name - - Residence artment HouseO Commercial EDTrailer Court <br /> Installation will serve; -------------------------- -- ------- <br /> ------- 'eZ <br /> Motel [:]other a -Garbage Grind ---- Lot Size <br /> Number of living units------ ---- Number of,�droomp- ------- - ------------ . Private C3 <br /> I I <br /> Water SuPPIY-. Public System and name ---t�I ---------W Tf Peat❑El Sandy E] Clay Loam <br /> Character of soil to a depth of 3 feet: San silt 0 cic%A� -----------------I---------- <br /> Chara Fill Material _/. ..... if yes,type <br /> Hardpan El Adobe 12/ <br /> must be placed on reverse side.) <br /> tc <br /> buildings, etc. <br /> n to wells, <br /> io <br /> showing size of lot, location of system in relation to wells, <br /> (plot plan, blic sewer is available within 2100 feet <br /> tted if V I <br /> N INSTALLATION: SNo septic tank or seepage pit permi lyj V ------------ Liquid 'Depth ------- <br /> EW SEPTIC TANK Compartments --- <br /> PACKAGE TREATMENT <br /> Type Material- ------ <br /> Capacity Foundation ----------- Prop. Line — --- <br /> ngth -------- <br /> Distance to nearest. Well -------——------------------------ -- ------ Total Le <br /> No. of Lines ----/------------- ---- Length of each line-- ---e_j�.------------------------ <br /> -ke-pth Filter Material ---- <br /> LEACHING LINE D' Box Type Filter Material __JAZ ov ..... property Line. 47--/............... <br /> Distance tom earest; Well -----­`--------- Foundation - ----- --- Rock Filled Yes C <br /> /J---- Number -- -------------------- 71 <br /> Depth ------------ Diameter 3-51 <br /> SEEPAGE PIT --------Rock Size --- <br /> Water Table Depth ---------- ----,10-........ Prop. Line ------- <br /> 7= Foundation <br /> Distance to nearest- Well <br /> Dote ---------------------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit -------------------------------------------- <br /> ------------- ------------------ ------- <br /> Septic Tank (Specify Requirements) ------------- <br /> - <br /> ------ ----- <br /> ----- --------- <br /> Di osal Field (Specify RequiremAents _/d&- - - -------- --------- - --- <br /> Isp <br /> -7 <br /> --- -- -------------- ------- ------- <br /> ----- -- ------- - ------ ----------- -------------------------- ------------------- <br /> ------------------------------------------------------------------------------ <br /> -------------------------- ---------------------- (Draw exis#ing and required addition on reverse side) th Son Joaquin <br /> application and that the work will be done in accordance <br /> Chereby certify that I have prepared this ca oaquin Local Health District. Hiirne owner or licen- <br /> County ordinances, State Laws, and Rules and Regulations of the Son J <br /> sed agents signature certifies the following-work for which this Permit is issued' 1 shall not employ any person in such manner <br /> "I certify that in the performance of the WO afton laws of-California." <br /> as to become subject to Workman's Compens Owner <br /> -------- ---- <br /> 4-P Title ----- -------------------- <br /> - <br /> --------------- <br /> -- - - --------- ---- <br /> �/Jh <br /> Signed --- ----- ---- - -- <br /> I <br /> ----- ----- <br /> --------- ------------- ----- <br /> By (if other tho nerl 10 FOR-DEP1k1tTMENT USE ONLY <br /> I , �, k _V�--- -------- ---------------- <br /> CCEPTED BY -------C_� ------ ----------q--- ---------------- DATE ------V� <br /> ---------- -------------DATE-------------I------------------------------- <br /> APPLICATIONA ------------------------------------------------- <br /> BUILDING PERMIT ISSUED ------------------------------------------------------------------------------------ --------------------------------------------- ------------------ <br /> ADDITIONALCOMMENTS -- ------------------------------------------- -—----- ----------------------------------------------------------------- <br /> I--------------------- ------- ------ <br /> ------------- -"-------------------------------------------- <br /> ------------------------ --------- ----- --------- ---------VV ------- <br /> ----- ---------------------------- -------------------------------------------- - <br /> -------- <br /> -------------- <br /> Date <br /> ---------------------I------------- <br /> __ f, --- <br /> ------------ <br /> -------------- <br /> ------------------------- *_� <br /> Final inspectionby: --------------------------- <br /> SAN JOAQUIN <br /> LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />