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FO� OFFICE USE. APPLICATION FOR SANITATION PERMIT Permit No: <br /> Triplicate) <br /> Issued-----------�_, (Complete in Tri Date <br /> ---------- <br /> ------------------ <br /> This Permit Expires I Year From Date issued <br /> -------'�. <br /> construct and install the work herein <br /> LJ lotions: <br /> made to the Son Joaquin Local Health District for a permit to existing Rules and Regu <br /> Application is hereby tion is made in compliance wi County Ordinance No. 549 and e <br /> described. This OPPlica TRACT --------- - ---------- <br /> - A Ail <br /> tea -------.-CENSUS TP <br /> - -------- <br /> JOB ADDRESS/LOCATION Phone.- <br /> ----------------- ---------- <br /> owner's Name --------- <br /> city --- <br /> phone <br /> Address ----------------------------- --------- - --------License # ----------- <br /> mmerci <br /> Contractor's Name -------- ---- --- Court <br /> installation will serve. a—encie-Fl Apartment Ouse f-11 I I <br /> Motel E]Other ----------------------------------2111-1- --------- <br /> Grand r <br /> rooms - 9 orp <br /> Number of living <br /> units:____----- Lmber of bed -- -------G ba_ e ----------------------Private D <br /> Numb ------ <br /> Water Supply-, Public System and name ------------------------------- ---------- J Clay Loam <br /> - -.0 Peat"D Sandy Loom ,C] <br /> Character of soil to adepth of 3 feet: Sand siltio Clay F1 es,type ---------------------------- <br /> . Ir If y <br /> 11Hardpan ❑ ALbeV Fill Material---------- <br /> 1 .0 - i I be placed on reverse side.) \4 <br /> 1 1 6uildings, -etc. must <br /> plan, showing size of lot, location of system in relation to wells, <br /> (Plot I J J�,u-, I itted if publicisewer is available within 200 feet,) ------ <br /> (No se tit tank or seepage pit perm ------:_ Liquid Depth -------------------- <br /> NEW INSTALLATION: Size-------- �.,J­1111-------------------- <br /> SEPTIC TANKI 3 NO: Compartments ------------•---•--... <br /> PACKAGE TREATMENT i -Materia .......... <br /> Capaclty`------------- ------ Type -----------------a.. % _., - ----------------------- <br /> I Well tmJll�--------------------e!�ou-ndation ----------------------Prop. <br /> Line <br /> Distance�to nearest: k )7. total Length ----------- ---------------- <br /> ;1'k e< Length of each line.- -1.... <br /> LEACHING LINE No. of Lines ------------- atefial --------------------------------------- <br /> LEA, --Depth Filier-M <br /> CH L11"r- <br /> 'D' Box 11-------!--- Type Filter Material I Property Line --------- --------- <br /> 11. � yes [3 No 0. <br /> Distance to .neafest, Well ---------------------Foundation-:-_f_---­-1----I-------I Rork Filled <br /> I Number ------ - ---------- <br /> Depth -1-1------ Diameter ---------------- ---------- ------------I--------I-------- <br /> SEEPAGE PIT J <br /> --------Rock Size A <br /> ------:----------- � : I........ Prop. Line ---------------------- <br /> ,W0tEFrTobIe Depth -------- --- ------- <br /> �-J nearest- Well ------ ------- ----------------- ------Foundation <br /> Distance to <br /> r .' � _1__1 Date ------------------- ----- --- <br /> R51110AIR/ADDITIO (prev. Sanitation Permit# ------------------ --------- -----------------V, <br /> I -+)I V ---I-------------------1�------ <br /> N --------------- ------------- <br /> ---------------------- <br /> �e`nts) 11 ----- ---iZ? <br /> Septic Tank (Specify Requirei -- ---- <br /> - - --------V�----- ------- <br /> uirlement5#;AJ0_?_�__­_j_ - -9 "Ixe"AdrIc <br /> Disposal Field (specify Req --- --------------V <br /> ------------------------------------ ----- -------------------------------------------------I--------- I - ----- <br /> -- <br /> ------- ---------- ------- -----f--------------------m------- <br /> It-1- <br /> -- <br /> ------- - <br /> _t <br /> {Draw existing and required addition on reverse side) --- <br /> -------- <br /> -------------------------- <br /> ----- <br /> one in accordance with San Joaquin <br /> pplication and that the work will be Or or licen- <br /> I hereby certify that I have prepared this-0 s of the Sah,jouquin Local Health, District. HOMO own <br /> Laws, and Rules and Regulation <br /> County Ordinances, State Lwo ny person in such manner <br /> sed agents signature certifies the following-- <br /> "I certify that in the performance0of the work for which this permit is-issued," I shall not employ a <br /> l' <br /> —fion IdWi-of California:' I <br /> as to become subject to Workman's CompensaOwner <br /> Signed - ---------------- ------------------ ------- --- ------ <br /> ---—-- ---------- Title --------- .1,&------!------------------------------------- <br /> ---------- <br /> --------------- <br /> By ------ ------ ---- f--other-tha---- nerd ` <br /> FOR .DEPARTMENT USE ONLY <br /> 0 ------- <br /> DATE <br /> ------------ <br /> ---------------- DATE ---------------------------1-7---- ---- <br /> APPLICATION ACCEPTED BY, ----------------------- --------------------- ------- ----------- <br /> RMIT ISSUED <br /> -i!5�-------------------------- <br /> ------------------------- <br /> BUILDING PE --- --------- <br /> OMMENTS _J0------ - ----- -------------------------------------------- ------- <br /> ADDITIONAL C ------------ ------------------ --------------------------------------- ---- <br /> --------------------------------------------------------- ------------------------------------------------- <br /> ------------------------ i ----------------- ---------------- <br /> ------------------ ----------------- :--- ------------------ --- ------------------------------ <br /> -- <br /> ---- Date ----- -/ <br /> Final Inspection by, JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />