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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. 4w::-414- ----------------- ......M---- I-- ----------------- (Complete in Triplicate)• Date Issued - ---- --- -------------- ------- This Permit Expires I Year From Dot*issued ---- -----:-............. TJ Health District for a permit to constrct and install the work herein Application is hereby made to the Son Joaquin Local He a;. 5A9 and existing Ruliss and Regulations! atio ith County rd*nance N pp' d. This application is made in com ion it described. -23//01 /rte MMCSUS TRACT ...... ........ TION , fvzt��--- ---- JOB ADDRESS/1.04� Phone ------- ---------7-.... .......... Owner' Ncye, - -- ----- ---------------------------------- ------------- 110 111. .......... Clty---^. -�G --�— - ------------- - ------------------- Addres . ..... . ... ........ IA Phone --------- ------------------ ........License 0 Contractor's Nome ._-.. --- - - -------------- -- - ............................ []Trailer Court 0 k��4�� Installation will serve: Residence&yaApartment House C] Commercial Motel0 Other ...... ------------------------------------- Number of living units:.....y.. Number of bedrooms r----Garbage Grinder ------------ Lot Size ..........Private 3 Water Supply: Public System and name ................. ...cia-y...❑ Peat Sandy- - Loam Cl ay Loam 0 Character of sail to a depth of 3 feet: Sand El Slit C1 Hardpan [] Adobe 0 Fill Material ......... if yes,type ............................ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.)- NEW INSTALLATION: (No septic tank or seepage pit permitted if public s2vpr is available within 200 feet,) 31 A, ... PACKAGE TREATMENT I I SEPTI TANK 16r Sizedl.1.41 Z1X1 ...... Liquid Depth --V--:"..".,...;..... .. Vo...VNo. Compartments Capacity i-.A—------ Type&�- ; ---- Material- Q/o* Is 4re.. .t..........�Founcicrtion .....10---------- Prop. LiA .-r............ Distance to nearest: Well .... ............ Total "Length I --------- LEACHING LINE No. of Lines ------- --jr- -------- Length of each line "' f . I Material --Depth Filter Material. ............... ....... D' Box -�".Y`Type Filter M .1 . Distance to nearest: Well --------------- -------- Foundation - ----------- Property Line ..... ................. Number ..... .. ... Rock filled yes 0 No SEEPAGE PIT Depth .................... Diameter ....11, Water Table Depth --------........................ ........Rock Size --- --- -------- --------------- Distance to nearest: Well ........._.............................Foundation ............!....... Prop. Line :.........---------.-- REPAIR/` .......---- ........ DITION(Prev. Sanitation Permit# ........... .. ....... -------------- Date ------ ---- ----------- I--....) EPAIR/ADDITION `.- I ---- --11............. ........ . Requie ........... ......... Septic Tank (Specify =17— - - --.- - .... - —— , , ........... 7:- . ... ........... ..................... --------- ... ......... Disposal Field (Specify Requirements) ........... .................... ------- .............---- ----- ......... - -------- --------------- - ---- ----- -- --7-�— - ...... -----............... -........ .......... .......... ...... ...... (Draw existing and required didditiorl ........................... . ......... .......... ----------- ---- ...... ............ --- ----------t -6n reverse side) V cordance with Son Joaquin I hereby certify that I have prepared this application and that the ork will be done in at * owner of licen- sed Rules and Regulations of the Son Joaquin Local Health District- Hum County Ordinances, State Laws, sod agents signature certifies the following:-- ---------------- employ any person In such manner I certify t tin the performance of the work for which this permit Is issued, I shall not as to bec e subject to Workman's Compensation laws of California." I .......... ...... Signed . .... .. ................. ........ . ....... .. ......... Owner By --- ----- --- ..... ......... ..... . (if other than owner) , : —FOR...DEPARTMENT. USE, ONLY- ...... /* APPLICATION ACCEPTED By --- ma -- ?- -- ------------------------------------ ------ .............. DATE ...DATE . .... ... ------------ ---------------- BUILDING PERMIT ISSUED . . ............ . ......................... .................. .............. ADDITIONAL COMMENTS ... ........ ........................ .........-........ .......... --------------------------- ----- -------- --------------------------- --- ---------- .......--- - --" —7:..' -*_1--------------- ----- ---- ... .................. ............. .... .... ..... =---- ---:::_�.............. -.7------- ---- -- --- ------- ........-...........- a :q.* � ate -------- --- ................. Final Inspection SAN- JOAQUIN LOCAL HEALTH DISTRICT r . E. H. 9, 1-'66 Rev. Sim