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�FICEUSE- PERMITPermit No: --- -- ---'APPl1CATiON FOR SANITATION tete in TrIPUcatel 3 Date Issued •-• - •1' (Comp Year From Date Issued M Expires 1 Yeo This and install the Wo"" ` ......................_.."""-'. ermit to construct Rules and Reg 1 .---�-'.. ..............----------- ' District for o P ' Ordinance No. 544 and existing .............-•- Joaquin Loca{ Health t N ..._. ... • CENSUS TRACT $ `-� -------------- on is hereby made ro the In compliance with County APPI, is opPhcation is ma _.._..--..__.._.._ e do �•--- - - - v ��--.`1.----..........-.......__...__.-•--_...._.......phone ................... - ----.... a_.... JOB �DDR�E55/LOTION / �N - _................... ... - ...._....................._... --- - City Q .. ...._ - Own r s Name .- ......- License# -- s i AdcI ss ---� 9 Js¢' " - Trailer Cdurt '» -�- � Commercial - - RmeM House[] Con actor's Name . _ ` Residence Q Apa Garba9° .._.r i Installation will ser' Other .___.__.c%�•• " - v . lot Si" j Motel❑ i C,rinda ..<._-•--- ---"•---...... ..private �_.... Number of yedraams _- units:..-. - Sandy loam UO L m[I Nu her of living -` { Public System and name ------- - ' Snit© Cksy ❑ Paat Water Supe Y� SandT3 If yes,type •-•---'•--...._..... r of soil to a depth of 3 feet: Adobe[] Fill Material -•-•----- - revers side-1 C •j Ch rode Hardpan❑ etc. must b° placed on rev to wells, buildings, showing sive-of lot, location of system in relation if public sewer is available within 200 toot,) fitted _ Liquid Depth .-....._ _ .. (Piot pion, ' II TION: l ......---------- - ... Compartments ....... - -• Rw INSTALLA No se tic or seepage Pn Size----------- ---- . SEPTIC TANK i•l Material No. Come P I AGE TREATMENT 17 Typ° .:__..__.__-._ Foundation -----Prop.line_.._---�--- Capacity =- - - ----; .----`---••' i Total Length �. to nearest: Well --•---- --. Distance . . Length of each line---- ---- ... --- + Depth Filter Mdterioi .- Y No. of Lines -:.... .� L CHV`E 1rj � Type:Filter Material _...----------- - property Lin° .-..'•'--` ----• Foundation - •--- --"` Filled , 'D' Box ............ Ya ❑ No 1 -0istance-to nearest: well - Number .............:...-..- R 4 Diameter ..-__._...._.- _. 1 Depth - ------------------ -.• - - -R°dc Sim-..._ -' - Pf� tyle SEEP` PST L'1ation -------- water Table Depth - -FOund nearest:We .........i Distance to Dale .- ---- ." Prov. Sanitation Permit ..._..._....-_-..-_---..._ _.___, -,—. REPAIR 1 ..-- ( _ . ... Septic Tank lSPecify Requiremenisl -- Q '�•- •� - ` cif Requirements •- �• .-__.... Disposal(field (Specify _ .............: required addition on reverse stdel ul ' ---•-.-.._.... ...-.-{Draw existing'nhd regv li _- by "'_ - at the work will be done in accordance * o San t this oPP Uciation and that Joaquin local Health District. Nome owner or lice+ i I Certify that 1 have prepared Regulations of the San Ordinances, State Laws, and Rules and Reg le any PQrs in such mann County ; , , Permit is issued, 1 shall not employ sed agents vgnature certifies the following: t erfernnance of the work fornwhich this 21ifornia:' ..l certify that in the P ensation lows of Ca as to become subject to Workman•s CemP owner - /�w �V �^f - Title- BY ------ (If other than owner) ONLY _ FOR DEPARTMENT USE DATE -_ - y !f 1 —._-•• _- - ---------------• ------ ... .--_'-•--DATE . -----'-----.._-...---- APPLICATION ACCEPTED BY... - ...........__.... ._._..__. _..__..... BUILDING PERMIT ISSUED __.._---------------------- -- ADDITIONAL COMMENTS_-.-•--- "" - 7 .:.!. -----------------------•------ -----.-.-.___ Vials_. � �.ZI--••-- —.. y ........................._.._.._.__•___...._.._ _.............._.___ .....__._.-....._._......_-....-.............___ w -• .. - TH DLSTRICT Final Inspection by: - --� JOAQUIN LOCAL HEAL \ E.H.*'i _ 1-'68 Rev. 5M• _ -