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FOR OFFICE USE: FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 �� Permit No.- - --- (Complete in Triplicate) Date Vssued_/�-.�"7� r^-.----- - - - ---- - ------- - -- Y. ----- - ---- --------- Joaquin �This'Permit Expires 1,�Year From Date_lssued rLfi��Ond install the /Application is hereby made to the Son with CountylOrdin#anccesNo. 549 a d e t ng Rulrm T-tb tes and Regulations:work herein described. This application is made in compliance _ ..�•.� .w .._ _ � -( US GT TRA -- -------------------------- JOB ADDRESS/LOC I N--------- -- ----- k Phone -------- -. - ::. :.-.- Owner's N / -- - Name -s -- ---- dip } - ----- City_ --------�' Address- _ n -------------------- r -�L _ License # _. Pho e�. - � � � Contractor's Name---- -------- 71 _4C Court Installation will: serve: Residence Apartment House.E] Commercial ❑ i ❑ �7 1- otel * Other------ -------------- t . 3:. ❑ ` - t __.__-__ _- Number of living units_________ ______Number of.bedrooms-2 -Garboge Grindex_�.�G -Lot Si _--- - �� I U Private Water Supply: Public System,and'name , _:--. : _. : :::;. :__ 0 y Peat , andy Loam ❑ Clay Loam 0 Y - a Character of soil to a depth of 3 feet: Sand ❑ -Silt Cla ❑ ,❑ F v _ Hardpan❑*Adobe; ,�-Fill Material-_._'------If Yes,type---r=---- ------ --=------ of system in relation to-wells, buildings,.etc.''must be.placed on reverse side.) (Plot plan, showing size of lot, location y NEW INSTALLATION: (NQ�'septic tank"ior seepage pit permitted if public sewer is avo able withiL1g0i feet ,] SEPTIC TANK ,t ?/ Size' ---- - �G-�l u'd Depth , PACKAGE TREATMENT [ ] Y ' ! r Capacity--- =; :0 =TYtae?/J.t�- C,c atexial -i o.�Compartments .= a f Pro Line �- '73 7 Foundation----- = p J 1... D' ante to nearest:-Well-= _= : = == v i A Len th of each line.. Total.L, ngth ____ - --- _ LEACHING.LINE. [ No., f Lines- g � Lf�j--�1 'D' Box__-. _e,S_.Type Filter Material. �- - Depth Filter Material_,_^ - -i---.-- / _�f r . . i f , / _ ir._ Foundation- ... W. ' ... -------_-_-_ L 6 __ ________________-• _ - - ation --- _.Property roPer Distant o nearest: Well------- Rock Filled Y Diatr._.__-- ___. ------------ SEEPAGE PIT Depth `�,_ m3Number.. Wafer Table Depth-. -- --- - = Rock'Size_ . ------- ------`:Foundation_-'. f° P l p. Line._ 1 Distance.to nearest:.Well_ i REPAIR/ADDITION (Prev:Sanitation Permit# -------------------- Septic ------------ " Date---=---------=----------------=-------� ) Septic Tank (Specify Requirements),__='-=---__------------------------------: ------ -------------------- Disposal Field (Specify Requirements)........._-------------- --------------------------- ----------- { 1 ---------=-------------------- --=---------------- -- --- -- -- ------------ ------------------ i =----------- -- -------------- ------- ---------- --:------ (D�aw existing and required addition on reverse side} oa I hereby certify that-1 have prepared this-application and that the work will Lo be done Home ownerance with or'or`,licensed agents F Ordinances,; St6te Laws, and Rules.and Regulations of the San Joaquina-: signature certifies'�the Following: f "'�' . "1 certify thatmthe performance' of the work fog which s permiit is issue ► d; I shall not employ any person m such manner as laws of California." i to become subject to,Workman s Com-ensatioa P Y- Y,:- Signed r Owner I ' ----- -- ` - ------ - B a< ' Y ( f of er=than owner) J I •- r.,- -`—FOR DEPARTMENT-U5E'ONCY f L ---DATE.- 1 j 3'/7 APPLICATION.ACCEPTED BY-_ `------- DIVISION OF LAND.NUMBER-- -----------•-:-----------------; DATE------------------ ----- ------ ADDITIONAL COMMENTS'------------------ _____________ _____ --------------- ----" ----- --- ------- - Zo 6s------ ------- --------------------•- --- ----------------------------------- ----------------- -- - - - i -------- --------------- ---- --- ---- ------------ --- Date !! Final Inspection.by:."- "` F&s 21677 REV. 7/76 W EH 13 24 SAN JO UIN LOCAL HEALTH DISTRICT