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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Triplicate) r�i _ Z7p �O <br /> ---------------------------- t Z <br /> y ate issued __-"---- <br /> --------------------- This Perrnit Expires l Year From bate Issued <br /> ____ ____ ---------- <br /> made to the a n Joaquin Local Health District for a permit to construct an ins li the work herein <br /> Application is hereby saw ter/ Oar ,^�. • * -- Ni.. <br /> This application is made in compli�ce with County Ordinance No. 549 and existing Rules.and Regu ations% <br /> described pp s Jn/LI'r N73 [7�2. .-� .�?..i� _._CENSUS TRACT -- -- ,'. -�. <br /> JOB ADDRESS/LOCATION .-l�------= =f--'� t -� <br /> -�? <br /> �^ - 41.,-... _ _/y--------- ,s_ -- <'p-,'--'----Phone ;:: <br /> l7 c==Gr. ------ <br /> Owner's Name > : <br /> City <br /> '> -'' C2O-q---------------------------------- <br /> Address _ �__•.__,�_ nse /-7�3-- Phone <br /> Contractor's Name .--�' 2r! -------- ---------- --- <br /> Commercial ❑Trailer Court <br /> w`-,r f Residence!❑Apartment Hous 1t U t <br /> Installation vri11 serve: ri!. t. i ,� of!-- <br /> Motel <br /> f <br /> Motel ❑Other ?"_ fl!' i � •- <br /> t -." Lot Size ----------------- <br /> .�•f'3' 1. _Garbage Grinder ------ ----- t <br /> Number of...bedroom� --------- _ ___Private ❑ <br /> Number of'livmg units: /� - -, r rd x <br /> f' -�- , Cla Loam ❑ <br /> Wafter Supp1�: Public System and name _ Peat Sand Loam Y <br /> t--Clby'-] /Z. Y <br /> p Siq#L�d t <br /> Character of sol l to a depth of�3�Feet:�•-�'Sand'ET {_ . . e _'� ,� r.,. ` ---__- <br /> +,Harcipan ❑ Adobe:❑ Fill Material - - # --- If YeS-tYp <br /> T' to <br /> on reverse side.) <br /> t buildings, etc. must be p j <br /> i <br /> f (Pl'ot plan, showing size of kot, ocation of system in relation to wells, j <br /> NEW INSTALLATION: <br /> (No septic tank or seepage p+ permitted if pu% blic sewer is available witkiiri 200 feet,) <br /> ...., , - ---------- --- No. Compartments rich-:-^,_� <br /> SEPTIC TANK'[ l Size = <br /> - �i <br /> ui <br /> Prbp F <br /> PACKAGE TREATMENT ( ] -. eats --=:--•---- <br /> Material___-_----------------- <br /> capacity: <br /> � r <br /> C X <br /> Ts- <br /> S�1 N� Capacit i - Type --------------- ---- , � �tine:�-_-------=----------- <br /> Y€ -- ----- --- -------I-Foundation ------------------ <br /> Distanceto nearest: Well _--------- X Q Total Length :---z J- --•--------- <br /> Length of each line_- 2� <br /> No. of Linesi. ------r e i, -------•- <br /> LEACHING LINE , <br /> C-X 1ST/ry `D' Box --- Type Filter Material _ __.__i � Depth Filter Material-- <br /> ' --1-Q ,Property Line. ° --------- <br /> -57 .�„�.--�►•�.-..-M--�-^tt , FoundationNumbeX . <br /> Distance to nearest: Well __-1_L©--- r` Rock Filled Yes ❑ No C1 <br /> SEEPAGE PIT Depth .......... Diameter ---------- <br /> -----Rock Size -------------------------------- <br /> Water Table Depth ---------------------- --------------- •-- rop. Line ---------------------- <br /> ____-__-__ Foundation ------------ <br /> ------- P <br /> crest: Well - - <br /> REPA1(ADDITION(Pr vpSanitation Permit# -------------- -•----- ---------- Date _____ <br /> z ------------------------------------------------- _ <br /> Sept Tank (Specify Requirements) t t ( — - <br /> uireme Its) --- -------- <br /> Disposal Field (Specify Req------------------ <br /> --------------- <br /> --------------------------------------- <br /> i <br /> ---------------------------------------------- <br /> _ "-.___________5---------------------------------------- <br /> --------- <br /> __-"_______ ___________ ___________ <br /> ______________________ r <br /> .r...._,�......_�.....:�-��_�"I"-"�(Draw existing and required addition on reverse side) <br /> hereby <br /> certify that i have prepared this application dna th°itis work will <br /> Local Health D strict.nHomece towner or licenn <br /> County Ordinances, State Laws, and Rules and Regulations o I <br /> sed agents signature certifies the following: i 6rson in such manner <br /> "i certify that in the performance of the work for which this permit is issued, i shall not employiany,p, <br /> as to become subject to Workman's Compensation laws of California. <br /> 1. f 1 <br /> Owner <br /> Signed ------------- ----- -------------- <br /> ) _ ---•- ----- -- - ------ - Title - ---- �-- --- -- - <br /> -------------------------------- <br /> By _ - 1s' 'r'"^ <br /> x� n wnerj I(if other_than o � j FOR .DEPARTMENT USE ONLY <br /> z7 ------------------ <br /> DAT• ------------------------------------------ <br /> ----- ----- ------------------ ---•- ----- ----------------------- <br /> ------------ DATE -�--------•------ ----- ----- --------•- <br /> APPLICATION ACCtPTED By.'--------- ------ ------------- <br /> --`-- --- ------------------------ <br /> BUIL�kNGPERMIT ISSUED ----'-- 3 _-_-.---- .------- <br /> - <br /> ADDITIONP L COMMENTS --------------------- - - ----------------- ---------------------------------- <br /> -------------- ---------------- --`-- ------------ ------------------------------------------------------ '------ <br /> ----------------------- -- <br /> -- 7 <br /> - - -.Date ----�f-- � - <br /> `�1l?. oz�_ - <br /> Final inspection by- ------- --------- - ��--•-- _ ' �"� <br /> ,b ,--- --- .� - SAN JOAQUIN LOCAL' HEALTH--DISTRICT, <br />