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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.7.1__VX-� --- -------------- ------'-------- -- --------- (Complete in Triplicate) qq l Date Issued 12- -l__.7-f This permit Expires i Year From Date Issue �� -- a permit to construct and he work Application is hereby made to odea compliance ec wiHh Counealth DtytOrd Ordinancerict describe No. 549 and existing Rules tand fi Regulations:tein described. This application is � p _ �� ®� CENSUS TRACT --------------------- JOB ADDRESS/LOCATION - -��---------��'___....&�,Iwrf�11� ' F ------- Phone Owner's Name -- /�s _0-------------------------------- city Address ----- License # I ------ Phone ��=----------•---•-- Contractor's Name /� f�Tl� �eE'(/ --------------------- --- artment Douse'❑ Commercial' TrailerCourt i❑ Installation will serve: Residence Ap ---*-------- � ` Motel er Lot Size --------------- Number --- --- Number of living units:---- --- Number of bedrooms _----_-__-.-Garbo e Grind w a _ PrivatezZ Water Supply: Public System and name ---------------------- ,. Clay.Loam Character of soil to a depth of 3 feet: Sand's Silt❑ Clay ❑ Peat [] Sandy Loam ❑ Y' ❑ 9. t Hardpan ❑ Adobe '❑ Fi11 Material --- if yes, type {Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) '' i3' it permitted if public sewer is available within 200 feet,) NEW INSTALLATION: (No septic tank or seepage p p t.4 �� TICTANK' Size--f X_� 's7------ Liquid Depth ;e_ ------------ - PACKAGE TREATMENT [ 7 SEPT'IC S _ Material s No. Compartments -- -----------•• Capacity�o �U�'h'`Type f I i P Distance to nearest: Well=�-� '..- ---- -foundation _-�Q- ----------- -- Prop. Line -- ---------- aw S oaTotal Length --------- ------------------ k-- ---`------ Length of-each line/ - I LEACHING LINE [ } No. of Lines ;- - ��i( _De th Filter. Mafierial --- -- ------------•------------------•'--• I D' BaxD-__-- TYp e Filter Materialt_1p , 4 t Line �to nearest:�Well -- :�------ - __ Foundation _.�— -___--__-- -- roper ----- ---------- Diameter ----------------Number ---- ------------------- Rock Filled Yes ❑ No i❑ SEEPAGE PIT [ ] Depth ce = 1 Water Table Depth ----- -------------------Rock Size ------------------------------ ----------------------- ------------------- Foundation -------------------- Prop. Line 'i Distance to nearest: Well .-_---_--__-_ -_-- - 'I ; = %, ---- Date -------------------------------• ) k REPAIR./ADDITION(Prey. Sanitation Permit# -------------------- -. Septic Tank (Specify Requirements) ---------------- ----------------------- - ---------------------------------------------- � Disposal Field (Specify Requirements)mems ------- ------------------------------------- - ----------------------------------------------------------- - - - - -------------- ---- ----------------------------------=---------------------------------------------------- - ---------------- ------------------ ----- -- - ----- - - (Draw exi-sting and required addition on reverse s d e ce I hereby certify that I have prepared this application Regulations d that the San Joaquin be doHealth D strit„Ho ettowner or liceh Son n- sedCounty Ordinances, State Laws, and Rules and sed agents signature certifies the following: ersan in such manner "`1 certify that in the performance of the work for which this permit is issued, I.shall not employ any p tion laws of California." as to become - -- ---- -- --------- su ect to Workman's Compensa --------------- Owner Signed -�- -Y:-� - ------- -------- --- ---------- -------- - - ----------------------- Tit e ------ ----- -- ---- -- ------------------------------- - ----- ------------------------- -- If o r than owner) I FOR .DEPAtt.TM T USE ONLY - ------- .DATE ...jj_Z�.-� -------------------- --------- APPLICATION ACCEPTED BY -- ----------------- ------------ ------=-- ----- ------- BUILDING PERMIT ISSUED ------;-1--------------------- - ------------ -- ADDITIONAL COMMENTS - ;' ----- ---- ---- ------ ----- ------------ = - ------------------------------------------------------------ --- -- ----------------------------- - ---- -------- - - -- -------------------- Final Inspection b -- ------------------- SAN JOAQUIN LOCAL HEALTH D TRICT E. D• 9 1-'68 Rev. 5M.