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FOR OFFICE USf-. m' a APPLICATION FOR SANITATION PERMIT Permit No. ------- ----- ;Complete in Triplicate) 6—��'f Date Issued ----- --------"_--- ------ -- --- -------- This Permit Expires 1 Year From Date issued .__-------------- - ermit to construct and install the workherein Joaquin Local Health D++strict fora p Ve ulations: Application is hereby made to the San Joaq I+once with County Ordinance No. 549 and existing R lication is made in compliance TRACT described. This app tL JI/uo,E� ----CENSUS --------------• JOB ADDRESS/LOCATION f._.---- ---------- -----------Phone �rl-- r__7 .. City - yp Owners Name -- - -- --------------------------------- JOB -- --•- -------- ---------- pp , Address - - it --- �{ - -=Q- --- -�- - --------- --------- ---------- License Phone __ __ _ /, Contractor's Name ---- -------------------- j artment House'O Commercial .[]Trailer Court Installation will serve: Residence�4 Ap Motel [3 other -------------------------------------------- _e Lot Size .. 0 _ _-- arbage Grinder ------------ Number of living . Private [� units:__-_f_._-_ Number of bedrooms ---Z�f' rl -------------------------- ---- --- ---- ----- Clay Loam f Water Supply: Public System and,name ---------- Clay 0 Peat❑ Sandy Loam -0 I Silt:O � Character of soil to a depth of 3 feet: Sand �' _.._._.._._."---.----- - - Hardpan ❑ Adobe Q Fill Material _- _.-.-- if Yes,type ---------------------------- Hardpan laced on reverse side.) size of lot,`location of system in relation to wells, buildings, etc. must be p {Plot plan, showing i it ermined if public sewer is available within 200 feet,) tic tank or seepage p p ------ Liquid Depth -------------------------- ------- ------------------------- L '� k NEW INSTALLATION: [No septi Size--------- ------------------------- ' SEPTIC TANK:[ I Compartments -------•------ PACKAGE TREATMENT [ ] ,+ - teriai------------ -------- No. Comp ` Capacity --------------- Type Prop. Line ----------------•----- 1 4 11 Foun ation -------------- -------- ----- ------- a, Distance to nearest: Well Total Length ---------•--- i No. of ---- -- -- --------- --- Length of each line--- ---- - -------------- --------------- LEACHING LINE [ ) -------------------------- . epth Filter Materia :----- ---- T e Filter Material ----------------- ---Box ------------ Yp Property Line. --------------•--•-•--- , Foun ation --------------------- Distan' to nearest: Well -------------- -- Rock Filled Yes ❑ No C3 Diameter - ------ mbe, - SEEPAGE PIT [ ] Depth l�..- ---Rock Size -------------------------------- ----- ------------------•------ Water;Table Depth -------------- Prop. Line ----------•--=•------- Distance to nearest: Well --- ------------- •-••Foundation -•---- ------- ------------------ ---- Date REPAIR/AD DIT ION(Prev. Sanitation Permit ) ------- ----- `I Septic Tank (Specify Requiremen s ."----- - ---------- --------------------------------- q Disposal Field (Specify Requirements) - - .. � ------ --- - - ------------------------------- r - .._._...- 4 a I F .l-f-ice---`-- X --- ----- ------��- + (Draw existing and required addition an reverse side) that I have prepared this application and that the n Joaquin n Loca Health Dstri t Homeance to owner or 1 cen- done in OccO I hereby certify County Ordinances, State Laws, and Rules and Regulations of the q person in suc manner sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, I shall not employ any as to become subject to Worlcma Compensation laws of California." ------ ----- ---------- Owner --- ---- Title ----- ---- - --- ---- ---- ----- - -- --- ----------- k Y {If other than owner) FOR DEPARTMENT USE ONLY DATE 1�� `------ --- - DATE - ----------------------------------------.. APPLICATION ACCEPTED BY -----.._. --- ------------- BUILDING --- BUILDING PERMIT ISSUED -- - --------------------------------------------•------------------------- t ------ AppITIONAL COMMENTS -.I I------------------ ------------------------- -----------,t - - -- i ---------------------------- Final ------------------- ------------------- --- Date ./ :- -- ��---- ---- ---------------------------------------------==------------------------------------------- --- - ------ ------ ----------- Final Inspection by: -"---------------- -� - - -- - --- SAN JOAQUIN LOCAL HEALTH DISTRICT P u 4 1-'68 Rev. 5M