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FOR OFFICE USE: Permit No,APPLICATION FOR SANITATION PERMIT �8 102 _ -- R `x ---------- (Complete in Triplicate) 1 x#' t�= - Date issued -9:7 n -- -------------- ------------ - This Permit Expires 1 Year From Date slue - -------------------------------------------------------- - 1 the work herein i Application i hereby made to the San JoaquinIian ec wiHh County No. 549 and ex sting Rules tand Regulations-. described. This application is made in compliance „ f CENSUS TRACT -----------------•-------- JOB ADDRESS 11 CATION "- - � '_. - one --- ---- --------------- P Owner's Name --"- ---------------- Address - -- --- ------- - 7 -----------------�Q7 I -- ��[� L'cense # -- -- ------------ Ph ne < Contractor's Name _-____"._"- -- installation will,servA-4 e: Residence Apartment House'❑ Commerc Motel ❑Other -------------- -------------------------- �irl+J-------- Number Grinder ""--- ---- Lot Size ---- ---�- ----------- ---- Number of living units:___.- ---- Number of bedrooms ----- -_-- _ Private -- ----- y Water Supply: Public System and namepeat❑ Sandy Loam ❑ Clay Loam ❑ Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ —Fill-Materia ------------ if Yes,type ----•--------- --- - -=--• I ,. —Hardpan E] Adobe. Fill- a laced on reverse side.) (Plot plan, showing size of lot, iota#ion.of system in relation ,.1*if pd�s1,i b`s`e'�7r ils it ble within 200 feet,) NEW INSTALLATION: o septit flan -ors e'pit permitted p _ z _X Liquid Depth - SEPTIC TANK'° - f PACKAGE TRf�TMENT [ 7 No. +ompartments ___------- e �_'__ ate (a, k G�ip'cicity Type " r �Y c' A ! `�c-- --------Foundation ___1�------------ prop. Line Distan qe to nearest. Welk 0 � �e------------- . __-_ Length of eat [in LEACHING ----- Total Length :"--� ---- LEACHING LINE ( } No. ofLines ___ �-p vT a Filter Material --Depth Filter Material ------�1�-------------------------------- �J D' Box -- YP Line -- ;--- Property . ------ ----- Distance kta nearest: Well __- -" --- ___ 1Fou dation _---- t __ _ Rock Filled Yes [] No i❑ , Depth Diameter Number ----- S_EEPAGE PIT [ ) p --------- ---"---- k ! Water Table ;De th Rock Size "_-""------- I -- = undation -------------------- Prop. Line --------------------- to nearest, Well --------------- I i Dat ---------------------------------- REPAIR/ADDITION --------------------------------- REPAIRfADDITION(Prev. Sanlfiation Permit -----t ) fi -^ = ------- --- Septic Tank (Specify Requirements) �-----------------�-�- -- ----------------- ------------------------------- ----- ------ ---•- ------------- Disposal Field (Specify Requirements) -_-----"---, , ------__ ---------------------- -------------------------- ------------- ---- ------------------------ - ------ ----- ----- ------- --�- ---- _ T(Draw existing and required addition on reverse side) rk will be o ce th San acluin I hereby certify that I have prepared this application and th tthe San Joaquin Local the wo County Ordinances, State Laws, aHealth Distrne in ict. �tHomeowner or cen- nd Rules and Regulations x sed agents signature certifies the following: erson in such manner "1 .certify that in the performance of the work for which this permit is issued, 1 shall not employ any p as to become subject to Workman's Compensation laws of California." --------------------- Owner __ f Signed -- ------ ------ -- ------------------------- Title -------------- By i {If other th caner} FOR .DEPARTMENT USE ONLY DATEi____'l__._�------------------ - APPLICATION ACCEPTED BY _-- __-" ---- t DARE ------------------------------- ---------- BUILDING PERMIT ISSUED - _ ADDITIONAL COMMENTS __. _ - ----- --- - -- -- ----- ------ _ __ J'� i { -------------------------------------------'- - __ ---- -- -- ___ ___-------- ___-- ---- ----- - �- -----------Da----- -------------------- ------------------- _ :` _ e Final Inspection b -------------------- ------rN-------------- - rrr�� _Y . w SAN•'JOAQUI 'I AL H H 1 TRICT E. H. 9 1-'68 Rev. 5M