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FOP OFFKC�E USE: APPLICATIW Fok,,SANITATION PERMIT permit NO. <br /> - - -------- ----- ------------ <br /> plicate) <br /> ----­-------------- ........... ...... (complete in Tri 3-7 <br /> Date Issued ............ <br /> .......... <br /> . .... .... .... Year From Date Issued <br /> ........................... <br /> This Permit Expires 1 <br /> ............. <br /> ......... construct and install the work herein <br /> at Health District for a permit to r Regulations- <br /> Application is hereby made to the Son Joaquin Loc Ordinance No.:,.549 and-exist! b.�ules and <br /> e in compliance with County <br /> described. This application is mad • <br /> CE <br /> ;9 t <br /> NSUS TRACT .......................... <br /> N .. ...... ........... ---- -- ­­- <br /> JOB ADDRESS/LOCATION .......... ------ -- <br /> ESS/LOCATIO <br /> A ................................. <br /> Owner's.Namerail.. ............ <br /> City ........... <br /> ------------------------------ <br /> Address ----------------------- ----------- .......... Phone <br /> it — ;....License# <br /> --- -- ­- ---- ---- - <br /> Contractor's Name --_------------------Residence- -, * 'Apartment House O!Cor�mercial oTralle;rCourt C1 <br /> installation will serve: Motel ❑Otheir -------------------------------------------- <br /> - <br /> Size ............ <br /> Number of living units:... ------- N bedrooms 4........Garioag� Grinder ------------ Lot <br /> um umber of becirc ._...__.._Garbage <br /> ...........".!............ ............ ......Private <br /> Water Supply: Public System and name <br /> .:Peat E] sandy' Loam ❑0 Clay Loam.cl <br /> Character of soil to a depth of 3 feet: Sand silt[3 Clay 9------ <br /> Hardpan ❑ Adobe [3 Fill Material -y-t- if Y4,type <br /> ` riLst 'be everse side.) <br /> location of system in relation to wells, buildings, etc.,'r <br /> (plot plan, showing size of lot, I . <br /> itted if public sewer is OV911-able,within M ieet,)­ <br /> NEW INSTALLATION. (No septic tank or seepage pit perm Liquid ,De h ------- ------------ <br /> ............ pt <br /> Size------- ...........;­­- <br /> SEPTIC TANK[ I prtrnents ...... ....... <br /> PACKAGE TREATMENT No- Corn <br /> ty Z _i9fA_13... Mat6rial JC <br /> Capaci Type prop. Line 106 <br /> i 'n <br /> j nearest- Weil Fourlaot 0 <br /> .......... <br /> Distance to. Total Length' ----------------- <br /> No. of dries ........ Length of each line../60,2.:­_..­,. <br /> ........... <br /> LEACHING LINE I B.Depth�,',Filter Material ----------------- <br /> --------- [ter Material-1- <br /> V Box.-j........ Type Filter Prop Line <br /> Foundation erty yes.jg No 0 <br /> Distanceito: nearest: Well Rock Filled <br /> Number <br /> D th Diameter ----------------- <br /> t: VH ep size ........... I--------_-- <br /> LEEPAGE PIT 4Q <br /> P`Woter. Table Depth -------------- ---------- Prop. Line ........ <br /> .......Founcicition-:7� <br /> to nearest* Well ..---------------------------- •t . " <br /> Distance ............... <br /> .......... Date ............. <br /> t n Permit <br /> ----------------- ------ ................I------- <br /> RIEpAIR/ADDITION(Prev. Sonito 10 ............... ......... <br /> .......... -------- <br /> Septic Tank (Specify Requirements) _____________•••- _ ------------------------- ------ .............................. <br /> ............... <br /> Disposal Field"[Specify Requirements) _---------------------------- --------I.............. ......... <br /> .................. <br /> ---_---------------I................................... ............................. <br /> I............................................ I ---•._--••-•----..__._- <br /> i <br /> ........... <br /> -----------------­­.......... <br /> ­---------­--­* <br /> --- <br /> (Draw n reverse side). <br /> ----------- ................. ............ <br /> (Draw existing and required addition o <br /> k Will be done in accordance with Son Joaciluiril. <br /> prepared this OPPIicctlon and that the war ealth District. Home owner or licen <br /> I hereby certify that I have P ns of the San joaqui I-OcOl H <br /> Laws, and Rules and Regulaflo <br /> County Ordinances, Slate Law <br /> sed agents signature cartifii..s the following- 17- t employ any person in such Manner <br /> once of the work for which this permit is issued- shfill no <br /> . " . 1. i -t <br /> o r ni a <br /> "I certify that in the perform f <br /> as to subje t to W kman s Co Penfic•an ICKWS Of <br /> nr", <br /> wr <br /> beco whe <br /> 0" <br /> ----------------- <br /> ..... . <br /> Signed _ • <br /> ...... <br /> ........ ... <br /> Title .... -••--•------. ............ <br /> ------------- -------------------- _- <br /> By . .................(if.-other- - - than--owner! <br /> t FOR DEPARTMENT -WE ONLY <br /> DATE ----- <br /> .............. ........... ................. <br /> APPLICATION ACCEPTED BY ............. _DATE ------------------------------------ <br /> .........................•-•BUILDING-PERMIT ISSUED . .................................. ----------------------- ............... <br /> ...............•...........I....... ... .............. .................. <br /> • <br /> ADDITIONAL COMMENTS ......._.......... .. ............ ... ........................................... <br /> 4 - --- .....................__------I....... ----- <br /> -_ I.... .... ............... . ......... ----------------- .........­.- <br /> ------------ ........ . ------- ---- -- ---------- <br /> 7 (- -------------------- ......................... ------ - ............... <br /> .. ..... -- ---- ................. .-...-.Date <br /> ..................... <br /> ................ <br /> .......... .. <br /> .................. . .... . ............... ------07../...... ... <br /> Final Insp,dction by: JOAQUIN LOCAL HEALTH DISTRICT <br /> V N 4 1-'d8 Rev. 5M <br />