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_........... FOR OFFICE USE APPLICATION F4R SANITATION PERMIT permit No. �1-_s�-r� - (Compl'e'te in Triplicate) ------------------- - Date issued -�}- - 7f ------ -------- -------- `--"------- 1,- This Permit Expires l Year From Date issued l the work herein ------------------------------------------------- - - --- permit to construct and g Rulestalnd Regulations: compliance with County Ordinance No. 349 and existing Application is hereby made to the co Joaquin �n Local Health��District for a p so described. This application is made ' t 1 -- ---- - -- ---- ---- -- TRACT ------------------ .-CENSUS- - --- -Phone -------------------------- -------- ----- -------------------•---•----- JOB ADDRESS/LOCATION . _ -- �.- --1 . �1 �4 ---- ---------------------------------------------- Owner's Name city v � ��7._� -----�--- -- - - --- --- Phone --- -------- ---------•------- Address ------ License # ----- OWN Contractor's Name ----- -- ------ - Residence [Apartment House'❑ Commercial {]Trailer Court ,❑ Installation will serve: Other ------------------------------------ f�CE- Motel ❑ - ------- age ---- - �_-_Garbage Grinder �--- Lot Size -- - --- _ _ Number of bedrooms -- --- ----_--Private. k Number of living units:._ --- -- - --__ m --. --- --- w Clay:Loa ❑ l public System and name:_.-____ :��_ Sandy Loam ,� Water SuPP Y= ,..:_.-._�. - Silfi - - Peat ❑ - .__..... , � .-•..- _ —_._.. r Character of soil to a depth of 3,feet San type ------/Hardpan ❑ Adobe'O Fill Material _. - if yes, etc. must be placed on reverse side.) ` Ian;showing size of rlotJocation of system in relation e�ofW Publills,c availabl within 240 feet,i' t'� (Plot p -. _,__..w , seepage pit perm r P ' a -- - Liquid Depth --- ,---- ':+---------.-•--- 51=PTlC TANK Size__---.'------ -------------------- NEW INSTALLATION-TREATMENT [No septic tank or La] f)TEF PACKAGE , N Compartments '.------ - Ty.pe ------------------- Material CopoeitY ------ti = Prop. Line - 4 `� q ------ Foundation - nce to neEiF t -1�e11" f. ,.------------- c • 3 --- {" th Filter M er,al J�'i Total Length -------- Length of/each line------------------- A �:•,� ,s a LEACHING L1NE� [ ] No. of Lines ;e `�-------- - 1 t Dep A r�. w<; 'D• Box ----------- T Pe Filter Material Property Line _-------- R --- Foundation ------------------ .... 4 No C3 1 Distance to neare t: We11 _---- -f = es �] -Diameter -- ---- Number - F - _- -- __ _ - ARock Filled _.._..:_.._.:.�__.-. -------------- SEEPAGE [ ] . Vllater.lTa`,ble. De ---- .--- _- Rock Size ------- Prop. ti#e 1--•---: --- ,aka; jr. w. r ----- oun atio i F d n Distance`to neare Well„4 r ,�9 f t { ... r-------- - Date --) Prev. Sanitation�,:Per(n;t# -----�-; , t� ..-:a°,? � -_�= REPAIR/ADDITION Septic Tank (SpecI.ify Requirements) =T� ! „ , _ = Disposal Field (Specify Requirements- — ';1 '- AC PJ`fiC H _ 1 � Q ------------- ---- - -- 4— -- l ----- � A.c.+ _ U - -'-- --- - � � P�_1- ----- I (Draw existing and required addition on reverse side) i wo certify that I hJoaquin ave prepared this application and--fK_dt'th San .loaquin Local Health D strc t nHomete ttownh So er',or I len-s l hereby Y County Ordinances, State laws, and Rules and Regulations of the person in such manner sed agents signature certifies the followin permit is issued, ! shall not employ any p ; "1 certify th in th'e' p r'.rriance of 11e ork for ch this p t � ensation ws of California." as to beco a b1e 1Ncirkman s p s Owner !�' - - ---------- Si signed ; g _*7 Title ---------------------- -- By -- -- -- ------- `------------------------------------------ i (lf�ot- than owner) t FOR DEPARTMENT USE ONLY n 7DATE' � t1---------- - ----------- '. . -- - F:_-- ~= DATE- :., _ �-k__--. ----- - APPLICATION ACCEPTED BY�t/�+- - -- - -- --------------- - :- � �7 - � __,_ BUILDING PERMIT ISSUED --a_ _�=M-- -T�-�' - ,; .. - ---------------------- ---------------ADDITIONAL COMMENT'S_.-_a- - -------------- ti , - __ - - - - _ <� -� __ - -- _ - - ----------------------- - �- - Date --------- ---------- ---- - � - Z. ---------------------- ------- Final Ins ion by: ----------------- ------ -- - SAN JOAQUIN LOCIAL HEALTH DISTRICT .... n__- CAA