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FOR OFFICE USE. R SANITATION PERMIT <br /> APPLICATION FOR Permit No7n_N <br /> R OFFICE <br /> - -- ----------- <br /> 10 <br /> ------------------------ (complete in Triplicate) <br /> ' 3 7.1" <br /> Date issued <br /> ------------ ---------- This Permit Expires 1 year From Date issued <br /> - ------------- <br /> ----------------------------------------- <br /> and install the work herein <br /> cal Health District for a permit to construct and Regulations, <br /> ion is hereby made to the Son Joaquin Lo nd existing' Rul_es- <br /> Applicat ation'\Is made in compliance with County Ordinance No. 5A9 0 <br /> �4 Y n�d, exist s <br /> described. This aPPlic ENSUS TRACT ----------- <br /> -------------- <br /> `ADDRESS/LOCATION -A--- <br /> JOB j ----------Phone- ----•------ <br /> ------ <br /> --- ------- <br /> - - - ---------- ----------------------------------- <br /> Owner's Name ---- iil�5_ 0------- - -- - - --------- <br /> CitV------- ----- <br /> .Address ------------ ----------- ------ Ph6,ne --------------- <br /> Contractor's Name - Trailer Court 'El <br /> I HouLse'D Commercial:n <br /> Install 6'ton will serve: Residence p artment I r: ------ <br /> Motel ❑Other -------------------------------------- ----------------- <br /> g <br /> --Z_�_ ........ <br /> Lot Size <br /> Numb5uof livingi ---- rof bedroom __ �arba_ge Grinder -----PrivateWaterpply: Public System and name --- ---I-----------------9� i Pp ,F Cloy Loam <br /> 0 at <br /> Character of soil to a depth of 3 feet. Sand'[] silt F-I'I Clay A�Soncly Loam El <br /> Fill M' terial ------------ if yes,type -------------------- ------ <br /> Hardpan El Adobe.671F a <br /> n reverse side.) <br /> of system_in' relation--to-wel I s,-bui Idi ngs,-etc.-must be plci6d a <br /> (plot plan, showing size of lot, location feet,) <br /> --I is available within.2QOI <br /> mitte'a 'if public sewer <br /> NEW INSTALLATION: (No se seep Or I Dipth $/---------------I <br /> septic tank or seep ge pi <br /> 'Liquid- <br /> -.—Siz N <br /> r7 a 5-//,;-z_�Y_ ---------- <br /> PACKAGE TREATMENT SEPTIC�ANK�[ Compartments <br /> ---------- <br /> , I i Material �v�_- No. Compar <br /> T <br /> Capacity TY <br /> e <br /> ype Prop\Line __1_5-------------- <br /> istance Ke ......... 7 dation ----42----------- .... <br /> fu --- --------.Foyn , I I <br /> to nea st ell - - ------- -jength --- ---- <br /> o ye .... ----------i__Length_of_each_line�� <br /> No f Li <br /> LEACHING LINE el� , ----/or-''� <br /> I I--- <br /> . .. .... Type Filter Material '-------Depth Filter Material <br /> Box Line ----- ------- <br /> Rock Filled 0 <br /> Jo '0 Foundation --------------- Property " " <br /> Distance 0 nearest: Well ----------------- -- `,-Yes <br /> Diameter S.3--------- Number .......::;P-------- ------- <br /> 4 <br /> Depth ------- Diam i <br /> SEEPAGE PIT ---Rock Size --- ----------1L. <br /> Water Table Depth ---------------------------- ---------- ----- 46.......... Prop. Lin' . ......... <br /> Distance to nearest. Well ----------- - ------ -----Foundation --- <br /> REP,�I.R/ADDITION(Prev. Sanitation;tion Permit# -------I------------------------------------ Date ---------------------------------- <br /> ------- -----------------------I---------------------------------------------------------- <br /> Septic Tank (Specify Requirements) ----------------------------------------------- --------------------- <br /> ------------------------------- ---------------------------- <br /> Disposal Field (Specify Requirements) ------------------------------------------ ---- ------------------------------ <br /> ---------------------- --------- <br /> ----------------------------------- <br /> -------------------------- -----------------------------/ ----------- ---------------------------------------------------------------------------------------------------- <br /> ------------ ---------------------------------- ------------------------------------required addition on reverse side) Joaquin <br /> i. <br /> " '(Draw eXLSting and requ with Son <br /> tion and that the work will be done in accordance wi <br /> I hereby certify that I have prepared this app 0 owner or licen- <br /> i3nd Rules and Regulations Of the Son Joaquin Local Health District.ict. HOm <br /> County Ordinances, State Laws; <br /> sed agents signature certifies the following: for which this permit is issued, I shall not employ any person in such manner <br /> -I certify that in thn performance of the work S <br /> ation laws of California." <br /> ation'0 <br /> jec compe <br /> as to become su Liec to Workmiil;�S'_ <br /> Owner <br /> Signed -------------- -----I--------------------- <br /> Title -- ----ezve_j--------- -------- <br /> ------------------------------ <br /> - - - ------------ ------- - <br /> --- ---- --- ---- <br /> By - ----------------(1f other- than owner) -------I <br /> FOR DEPARTMENT USE ONLY <br /> --- <br /> DATE <br /> B <br /> DATE DATE ------- <br /> APPLICATION ACCEPTED B - ------ - --- --- ------------------------------------------- <br /> DATE <br /> T E -----------------ISSUED <br /> ----- -- --------------------- --------- --- <br /> --- - ---- --- -- <br /> A <br /> BUILDING PERMIT ISSUED ----------------------- -- <br /> ADDITIONAL.COM ---- -- ----------- -------------- ------------------------- <br /> MENTS--------- -------- - lCiT <br /> I ---- ----------------------------------------------------- --- ---------- <br /> -------------------------------------------- - --------r--------------- ----- -- -- --- -- -- --- -- --- -----:--------- <br /> -- ---- ---- ----- --------- -- <br /> - ----- ------------- <br /> ------------ ---- -- ------------------- --- - --- ------------------------------------------------------- ------------------------------------- <br /> L A Date <br /> ------------------ <br /> ------------------- ------ --------- <br /> Final Inspection by: ------- - ------ - <br /> JOAQUIN LOCAL HEALTH DIST,RICT- <br /> E. H. 9 1-'68 Rev. 5M. <br />