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4 <br /> FOR OFFICE USE: <br /> APPLICATION TR.SANITATION PERMIT <br /> (Complete in Triplicate) Permit No: __,71__57 <br /> Q <br /> r <br /> ------------- <br /> This Permit Expires I' Year From Date Issued ` Date Issued --------- <br /> Y <br /> Application is hereby made to the an Joaquin Local Health Dis-trict- for a per to construct and install the work herein <br /> described. This application is made in complian a with County Ordinance No. 549 and exi t' <br /> 2�o(a k) � �v�a�� g ides a�d Regulations: <br /> JOB ADDRESS/ ATION ��RAzd . <br /> r SUS TRACT <br /> Owner's Name <br /> - -- -- _f f -_ Cp -�.�_Phone <br /> ------ -- <br /> Address �` <br /> ---- -- ---- ---- ' = �'- <br /> !� City _ <br /> - ..----------••----- <br /> Contractor's Na a --- � __--- -_ -- _ - :License # 3 - Phone <br /> Installation will se ' Residence partment House❑ Commercial ❑Trailer Court ;❑ <br /> 1 Motel Othery= <br /> Number of livin units:___ _- Number of Brooms <br /> g -------Go bci'a Grinder _ Lot Size ___ ____•- _ <br /> I_Water Supply: Public System and name ___ _ // � <br /> -- -- ---E--x`61 Private ❑ <br /> Character of soil to a depth of 3 feet: Sand'E] ilt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> max, <br /> Hardpan ❑ A yes, type -- <br /> Hard an Adobe i!I Material .�!f es a __________ <br /> I � <br /> (Plat plan, showing size of lot, location of system in relation to- wells, buildings, etc. must be placed 'on reverse side.) , 0'- <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if`public sewer is available within 200 feet,( <br /> EATMENT f ] SEPTIC TANK .l <br /> e ----- ------ Liquid Depth _�/Z <br /> PACKAGE TR- 1f►/�- <br /> Z--_ ----.-•-- <br /> TYo. Compartments -- ----- <br /> - <br /> Pe <br /> Distance to nearest: Well ---------- dation ..__ �_-__�_____ Prop. Line __s— <br /> Foun --- --•-------- <br /> LEACHING LINE No. of Lines ----- _ Length of each line___47 ------ Total Length <br /> Box,V'_C_S. _4ype-Filter Material _� _� _`.Depth Filter.Material ___� <br /> Distance to nearest: Wel! _.___ ----------_ Foundation _. �---r_-------- Property Line <br /> J <br /> SEEPAGE PIT Depth <br /> p ---ea�..��__--_ Diameter _ _ ;___ Number ------- Rock Filled Yes 'K No 0y <br /> Water Table Depth _______-- _ <br /> :_----Rock Size --- iL.sC <br /> { <br /> - Distance to..nearest: Well ____-__ _ ____,____;._Foundation _�_I�__- <br />