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FOR OFPIC'F USE, APPLICATIf;N FOR SANITATION MI Porm't No. ......................... ............. (Complete In TrIplitoto) ....................... .................... This Per Expires I Year From Date igived Date Issued ...... ............ ......................... ............ App!lcotlon Is hereby rnodo to the Joaquin Locc;l Health Dlstri,t fur a por-:t to cor.3trvc�t and instal) the work heroin descriL*d. This oppl-rotion ;s mode In compliance with County CruirionLO No. 549 and existing Rules and RegulatlOnst JOB ADDRESS/LOCATION 4r!(�-.. --fl,I'P. W....... . .... CENSUS TRACT .......................... Ownar's Name . ....... . --Pf ........ .... .................. . .. . ... .. . ........ .....Phone .......... ....Cit" JAI'xwrcc".-J. .................................................. .. ........ . ....... A,cicl(osc . .. ........ . ....... .... ......... .. ............................ Controctor's tslcma .... 'A,.Y..... .. . ...... .. .. .... ..... Phone Installation Wil server Residence C]Apartment House 0 Commercial oTrallef Court At motel 56 Other ........ ................. Number of liviW units............. Number of bedrooms ............Garbage Grinder Water Supply, Public System and name ... ........... ................................. ... ...........................I.....Lot Slie....................Private C.lay E] peat E] Sandy Loan', 0 Clay LOOM ❑ 10. Character of soil to a depth of 3 feet: Sand 19 Silt El - Hardpan C] Adobe 0 Fill M'Gterlcl .... ..... If Yes,type ........................... (Plot plan, showing s!ze of lot, location of systern in relatior. to wells, buildings, etc. must be placed on reverse side.) NEW INSTAILLATIONt (No septic tank or seepage pit permitted If pus;llc sewer is available within 200 feet,) Size......... ........ ......... ................... Liquid Depth ........................ PACKAGE TREATMENT SEPTIC TANK[ 1 Compartments ..?n--••- ... Capacity Moterlai.... No. Type ......Foundation ............... Prop. Line Distance to nearest: Well line ..... .�!57............ Total Length .... ................. LEACHING LINE No. of Lines . ...... .... ..... Lonjith of each, IJ .....E . 1, 'D' Box .... Type Filler Matoriol -$ .... ............... .. .. .--..Depth Filler Material ..... .. .. .. .... ... Foundat:on ...... ............. Property Line Distance to nearest: Well ......43 rnber ed Yes C3 NO 0 SEEPAGE PIT I Depth ... .... .......... Diameter ................ N u .... .. ...... Rock Fil' Water Tabid Depth ..... . ...... ... ... ...... ..... ... ....Rock Size . .... ...... .................. rorp. Line ...............-- Distance to nearest: Well .. ...... .. ....Foundation ............. ...... P REPAIR/ADDITION(Prev. Sanitation Permit It Date ..................................) Septic Tank (Specify Requirements) ................................ .............. ...... ... ............... ............... ....................... 41 Disposal Field (Specify Requirements) .. . ........----------- ------ . . . .. . . . .. .... .. . . .. . ........................ .. .. .......... ...... ... ... ......... ............ ................................ ................. .................... -------I....... ..... ... ....................... ..................................... ............................................. .... .. (Draw.existing 1.and-required.addition on reverse side) this applicciiion and that he yj�,L, will bc, done in accordurc* Vdth SO" -)"Win I hereby certify that I have prepared ulclions of the s(-,, Joaquin Local mealth District. Horne own*r at licel, Cc,unty Ordinances, State Laws,panel Rules and Reg sed ag.enis signature certifies the lollowing: which this permit is issued, I shal! not employ any person In sui:h manner "I certify that in the performance of the work for ,os to become subject to Workman's Compensation laws of California." Signed Owner .... .......... by 4- 0-01ITFI-Thnvownerl IFC�DEPARVAENT 05', ONLY DATE APPLICATION ACCEPTED BY DATE . .......... ............. . BUILDING PERMIT ISSUEDz. ............... . ADDITIONAL COM.MENTS . ....... ....... . .. ............ 1176- Final Inspection by: -,r 5rt4 ;w'[PICT 6/7L 3M DI 13 21: 1-68