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FOA OFFICE USE: APPLICAT164 FOILt SANITATION PERMIT Permit No. ... ............. --------------------------- .......... ;Complete in Triplicate) - Date Issued ...............1-111........................ .01 I This Permit Expires 1,,yrar_From Date Issued f ........... .......................... Application is hereby made to the -on J �Soaquin Local Health District fcio permit to construct and install the work herein described, This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: Orly L 41VEMS S4TRA�.� ......... ....... JOB ADDRESS/LOCATI$DU .......... ............ ............ 101 a, ......Phone ..... e e) ....;............... Owner's Name- .... .. ............. . ................ ........ Ci y ... C------- --- ....... t _Ze .... ..... Address ...... . ....... ....... ... &_*40 11l e # Phone ........................ Contractor's Name ...:............. . ..........r. . ---- - -- -- -- ----- --- --- -- Installation will serve- Resiclence'l�partment House,E] Commercial [DTroiler Court ❑ N, Motel Other ....... -------------- --------------- X16' u 0 • Number of living nifs...../.... Number of bedrooms ---------__Garbage Grinder4�� Lot Size ................--•- ••••- ❑ ................Private Water Supplyoublic Syste and name .............___---------........ -------------I................. .......... ❑ Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay E] Peat El Sandy Loom ❑ Clay Loam Hardpan E] AdobeV 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:. it permitied if pulalic sewer is available within 200 feet,) PACKAGE TREATMENT SEPTIC TANK Size-A ---------- ... Liquid Depth 01 Al C - I No. Compartments ...... ...... pocity 41ST Co Type Materia R— W Prop. Line �'y.......--•-- LEACHING ...... Distance to neare 7t--well Fovinclation..YJ............. P LEACHING LINE No. of Lines . :3Length of each line.. ........... .Total Length ------------ 'D' Box Type Filter Md6rial Depth 'Filter Material .... -I.av................. Distance to nearest:-Well/' Foundation . ...... -_1... ........ Property Line_..-4 ......... � No SEEPAGE PIT Depth ...... Diameter ................ Number . ............. ............ Rock Filled Yes 0 Water Table Depth ....._---------------- ... ........Rock Size --------- ---- ----------- ... ...... Distance to nearest: Well ...................................,.__Foundation ........... Prop. Line .... ................. REPAIR/ADDITION(Prev. Sanitation Permit .....•. Date ......... • Septic Tank (Specify Requirements) ...... .......... .... ........ ...................I......................... ............I........... . .................... ............ -------- ------------_ Disposal Field (Specify Requirements) -------------------------------- ----------------- ---------------I......................................... ................I......-11---------------------- -------- -........... ................ ..................------ I ------------------ .......__............. ....... . ...... ------------- ........... ............. .. .. ......... ........ ........Draw,existing and required addition on reverse side) an Joaquin County hereby certify that I have prepared this application and that the work will be done in accordance with S WLocal Health District. Home owner or licen- County Ordinances, State Laws, and Rules and Re-gulotions ofquithe San Jog I sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I %hall not employ any Person in such manner m as to become subject I Workma i Compensation laws of California." 0 Signed Owner .......... By . ..... ... ... . ... ---- -- .......... ------I....... .......... 'Title e than owner) FOR DONLY _ ENT USE ATE . ............. 5 APPLICATION ACCEPTED B .. ...... .. . ....... ... BUILDING PERMIT ISSUED .. . ..... ................. ......... --------- ........DATE - .......... --------- ....... ADDITIONALCOMMENTS ..................... ....................................... ........... ------------ ........_........ .... . .... -------............. .. .......... ..................•----.............._.._.._...__._. ..............._---------- - ----- - •------ ........ .............................. ... ....... ............ ................... .....r-.........�....... ..................... ............. .......... .. . ........-1 ............._......... ---------- _------------------_L1. . ........ ---- -- ----- ---- - Final Inspection by: .......... .... ... . ...... ---------- . . ................. ---Doti SAN JOAQUIN LOCAL HEALTH DISTRICT 7/72 3 L 't AA