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FOI FFICf`USE` '"� AppLICA1 ,11 IP R SANITATION P1:RNl1 3 g r Per it No: ` ---------�� =d--------- (Complete in THrpl�l-cats) 141, I.,ri iftma mat issued - I� d--- ' This Permit Expires 1 Year F;,rorn /el �* . . # ------ --- -------- ----- -- -- '--_- P: i ct and is hereby made to thetSdn Jti�ain squin Local Health DistQ o nQ Nor-- 549 and axis g Rules alnd hRegulat onsrein ae cicati® I cation is made in compl�anc yrx+ithvfGo nty� ; -e- ribed This application _ t ------ --- -- CENSUS TR CT ------ ---- Y . 920 . !� AD RES5/LO ATION Phone - ------- PI�Q . r O 'ner s Name Q.C71T�1Jla m - --- -- ---------- uc�l-p city S-Teel Wlt _ �4�� 9 07_-. ddress F3 Phone . ; D A. -� License # contractor's Name! ----------- .e l Commercial:[]Trailer Court .❑ will serve: - stallatin Residence Apartmerit'House'❑ Motel ❑ ------------ l� f�I�r units:_---,_----- Num er of be rooms __ -:----Garbage cinder NQ----- tot Size -- ----- - -•---- - ' - Number o g - vat - ---------- -----•- - --- pjt�ater, ly: Pulil,ic System and nae - Sandy Loam ❑ Clo LoaWM ❑ Character io1 socl to a depth of 3 feet: : Sand❑ ' Silt❑ Clay ], at❑ � Fill Mater.'ial ------------ If yes,type ------------- ardpan A. Adobe' h 4 etc. must be placed own,- vers side.) (Plot pla�il", showing size of lot, location of system in relation to weir, buildings, �, miffe—r�fp'blic sewer is available within 20 feet,) NEW INSp►LLATION: {No septic tarok or seepage'' `P Size-_ d depth :. ._ .. SEPTIC ANK `_- ------ � ----- - ----•- -- PACKAGIw,;TREAT ENT ( I Q ,- T . e Material No. Compartments Capacity--------- ----- ---- YP - ---- - FguAdationn- 'bistance -to nearest: Well -_----- Prop. Line LEACH�NGTotalLength ,--_---•-- -- ., I;ength�ofxea�h�Iirle-—-- ---- --- LINELJ ] No. of Lines : _ _ Depth Filter Material -------- I- - - e Filter Materia - p Box ------------ YP --------------- - -- Foundation ------------------------ Property Line. ------------------- Distance to nearest: Well ----------------------Depth e --_- --- Diameter ---------- ----- NumberNo . D ----------- ---- ------ --- Rock Filled Yes ElSEl`_PAGE PIT [ 1 p RockSize -------------------------------- Water Table Depth ------------------------------- -- --------i Prop. Line ---------------------- Distancelto nearest: We --------- ------ - - ------------ • Foundation Date ---•-----------) REPAIR/ADflITION(Prev. Sanitation Permit# --------------- 1760--- Lis�J `T79N 1C�--- iSeptic Tank {Specify Requirements) �t- -----QL�- N 1 - PS=lA P ) ----------- # Disposal Field (Specify Requirements) - --- , ---- ---------------------------- - -------------- = ----—----------- ---------- -�-------- � ---- - (Draw existing and re--wired addition on reverse side) rk will be o 1 hereby certify that 1 have prepared this application and that of the San Joaquin Local District. Home with Homeowner or licen p - County Ordinances, State Laws, and Rules and Regulations r sed agents signature certifies the following: arson in such manner "I certify that in the performance of the work for which this permit is issued, I shall not employ any„p I as to become subject to Workman's Compensation laws of California.” ---------------------------------------------- Owner Signed ----------------------------------- -- -- - ----------------- BY ------ ---------0lj - (lf other than owner) F EPAitTMENT 115E ONLY APPLICATION ACCEPTED BY -- ---- --- DATE ------------------ ------------------------ BUILDING PERMIT ISSUED -------- - - -- - - -- - --- ------- ---- ----------------- ADDITIONAL COMMENTS -------- - - - - -------- -- ------------- ---------------- ------------------------------------------ - ------------- ----------------- -- -- - -----------------------------------------=--------------------------------------------------------------------------- ----- --- Date -- �- �-=�-�- --- ------• - --- ----- -- - --------------- - --------------- -- Final Inspection y- ----------- -- --- JOAQUIN LOCAL HEALTH DISTRICT F. H. 9 1-'68 Rev. 5M