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FOR OFFICE USOAPPLICATION FOR SANITATION PERMIT <br /> Permit No.. <br /> --------------- (Complete in Triplicate) <br /> --------- ----- <br /> o <br /> Date issued - ------------- <br /> ---------- ------------------------ <br /> This Permit Expires 1 Year From Date issued 7 <br /> an Joaquin Local Health District for a permit to construct and install the work herein <br /> Application is hereby made to the S in compliance with County Ordinance NO'. 549 and existing Rules and Regulations: <br /> described. This application is made <br /> ----------- <br /> ....CENSUS TRACT ------------ <br /> JOB f ADDRESS/LOCATloti::::P--3��6k"'--.4r��� ----- 53 -3VI-1- <br /> _2 F---f----- <br /> Phone- <br /> X ----------_------------ ----------------------------- <br /> Owner's Name _,�_A_?4 - V/1---7 <br /> ---------------------------- city ----------------------------------------------- <br /> Address -------- - -- ------------------- - Phon <br /> ------License eV`: ----------------------- <br /> Contractor's Name -----7-,FX-A0yW--------------------------------------------- <br /> Tat i[]Trailer Court 0 <br /> Installation will serve: Residence t-4-artment House,F� Commercial t. I <br /> Motel r7 Other --------------------------------------------- AN, t5 <br /> -of/ - <br /> bedrooms ---Garbage Grinder ---—----- <br /> Nurriber of living units:---/-------- Number of - 1-1 .1-1 <br /> l <br /> . .- Private <br /> ------- <br /> --------------------------- ­�------------------ <br /> Water supply-, Public System and name --------------------------------- ------- ---------- L Clay,Loam.0 <br /> e_�_ . clay [] Pedtf] Sandy Loa El <br /> Char.I acter of soil to a depth of 3 feet: Sand'e Silt 0 -S" <br /> . -- ----- ---- - <br /> Hardpan MAdobe-E , Fill Material ------------ If yes, <br /> citio� of system in relation tawells, buildings,4tc. must be placed on reverse side.) <br /> {Plot plan, showing size of lot, 10c, , - 11�I I <br /> I — sewer s available within 200 feetj <br /> NEW INSTALLATION: (No septic tcnklor'seepage pit permitted if public 0 ------- <br /> --------- Liquid Depth ---------- <br /> PACKAGE TREATMENT ( I SEPTIICJTANK;[ I Size----,- Compartments ------------- -------- <br /> Moteiial---------------------- No. <br /> Capacity - Type -------------------rA p. Line --------------I------- <br /> I , -. Foundation ---------------------- Pro <br /> Distance o nectres�.7Well ------------------- i <br /> 1-il 11 "1' Total Length ------------------------------ <br /> 4 1 each line---------------------------- <br /> LEACHING LINE No. of Linel-,.,--------------------- Length of <br /> X.11 --------------------Depth Filter Material -------------------------------------------- <br /> 'D' Box t Type Filter Material <br /> J- .1 ee <br /> : ------. ',f&Yn-d&tT6—n _771----------- Property Line. -------- -------- <br /> Distance to,nearest: Wt LI ----------------- I - <br /> . C i. , Filled Yes E] No 01 <br /> . ..... ...... Number ------- Rock e <br /> SEEPAGE PIT D pt _J Diameter I---------------- -------- <br /> b ,-�+h 1:11--4 ---------Rock Size --------------------- ------ <br /> Water To"i —---------------------------------f--- <br /> ine ---------------------- <br /> -------------------- Prop. L <br /> Distancetonearest. Well - ------------------------ ----------Foundation <br /> I- Dot --------------- <br /> Sanitation Per'�it# ----------------------------------of---------- e ----- <br /> REPAIR/ADDITION(Pr i k�,_ ---------------------.------- <br /> I <br /> ------------------- ------- <br /> ents) ---!--------------------------- -- -;K - - <br /> Se tic Tank (S cify Requirem 7-- ---------------------- -- le X$I�Fle - <br /> , 1�1-, 75�e--- --- -------- <br /> -------------- <br /> iremerits)l ---------- <br /> I /Z3_7'1� -Aff I-- -------------------- <br /> DiWosol Field (Specify Requ 'A e <br /> --- - --- --- -------------------f-- --- <br /> ---- -------- ----- ------ <br /> ------ ------ —------------------------------------------------------ <br /> r ----------36--------------- - - <br /> _j addition on reverse side)' <br /> -- ---i--------------- 411. _+(Dra,��existing and required <br /> I hereby certify that I have prepared ithirk application and that the work will be done in accordance with Son Joaquin L <br /> County Ordinances;State Laws; and Rul&s and Regulations of the San Joaquin Local Health Distelct. Home owner or licen- <br /> sed agents signatdre certifies the following: any person in such manner <br /> 111 certify that ;n'tKfi performance-of t %W <br /> he -rkfor which this permit is issued, I shall not employ <br /> .. 1 .1 nsation laws of California." <br /> as to become subjectio WorkrAiiffi's Compensation <br /> Signed ------------- <br /> Owner 1c <br /> ' __ <br /> f I Title ` ------------- <br /> By <br /> (rf other than awn <br /> ,FOR DEPARTMENT USE ONLY <br /> -- DATE ------- <br /> APPLICATION ACCEPTED BY --- - -t------------------------ ------------------------------------------- --------------DATE - ------------------------------ --------- <br /> BUILDING PERMIT ISSUED _ j --------------------- <br /> ---------------------------------------- <br /> ADDItIONAL COMMENTS <br /> ----------- ----- --- ---- - ----- ----- ---- ------ <br /> ---------------------------- ----------------L--- <br /> - -- <br /> ---------------------------- i------------ -- ---------- -I----- - ---------------------------------------------------- --- ----- <br /> - t--_-_3----------- <br /> ------ <br /> - --------------------------------------------------- <br /> ----------------------------- ------ - ----------- <br /> --- ------ ----- - <br /> Date ------ - ------ : - <br /> FinalInspec - ----- <br /> -SAN�JOAQUIN, LOCAL HEALTH DISTRICT <br /> E71T 9 <br />