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s ;:__ -t.1.� 7l -? D �R OFFICE USI=: APPLICATION FOR SANITATION PERMIT Permit No. -. -- - --------- (Complete in Triplicatel 'f - ----- - --- ---- Date Issued -- k ------ `' -------- This Permit Expires 1 Year From Date Issue -_---_---�----- - erm;t to construct and install the work herein ------------------ ' Rules and Regulations: Joaquin Local Health District fora p Application is hereby made to the San Joaq Bance with County Ord;Hance No. 549 and existing lication is,made in compliance ---------------CENSUS TRACT- --------------•----- •- described. This app 5�----------- y_ - 7.7• � �."�--- ---_s,®-'- ---iy�o��"- --- - ----Phone -- - - --- --� -------------------------- ------ ------ - ---- - JOB ADDRESS/LOCATION -. �jj,�, 5 � �= cityT�� Owner's Name -%' � --------------- $'� Phone �= Address �r ------------------ .----- License # Contractor's Name _� commercial :0 Trailer Court ❑ Residence Apartment House'❑ Installation will serve: other --------------- 1r —O�/ j- ------------------ Motel 0 Garbage Grinder -O---- Lot Size - - - Number of living units:--- ---- Number of bedrooms -- -•------- Private ❑ ---------------- ------------ - Clay Loam ` Water Supply: Public System and name.--------- Clay ❑ peat❑ Sandy Loam [] Silt❑ - - Character of soil to a depth of 3 feet: rSan Adobe Fill Mater;al ------------ if Yes,type - Hordpan ❑ �) 1s buildings, etc. must be placed on reverse side.) ";!� (Plot plan, showing size of lot, location+of system in relation #o wells, [!� it ermitfied if public sewer is available within 200 feet, NEW INSTALLATION: (No septic tank or seepage p p // Liquid Depth - ,�/ Sizer - X✓�- qC PACKAGE TREATMENT [ ] SEPTIC TANK ��, r No. Compartments Material�" E �1� r Capacifiy �� Type '" Prop. Line Foundation -/a- --- Distance to nearest. Well ----- ©- � _ _ Total Length :-�1.�-�-�-------•----•---- �� No. of Lines - ( - Length of each line---- -- -- - - --- ------------ - -------- LEACHING LINE P1.. Depth Filter Material -- r e Filter Material -- - p' Box 4b ---- i'T p -` ` Property Lin Foundation -- No ❑: Distance to nearest: Well � �� Number Rock Filled Yes ] i ---- 7 Diameter �t! �/ Depth o� j F ------------- SEEPAGE PIT '. (?(1 Rock Size Water Table Depth -- �� • ------Foundation ---f Q -----•---- Prop. Line -- ----------••------ "-_-"- - Distance to nearest: We ------------ j . E - Date -----------------------------• REPAIR/ADDITION(Prev. Sanitation Permit# ---- ---- ints) ------------------------------------- - Septic Tank (Specify Requireme --- ------------------------ pisposal Field (Specify Requirements) ---------- - ------------ - ----------- --------------------------- - - -- ---------------------------------------------------- ------ -- --- - -- - -- -- k� --------------------- - _ -_---",--_- --" - (Dray existing and required addition on reverse side) prepared this application and that the work wi ll be do I hereby certify that I have rell Local health District.no in tHomece towner or 1 cel P P County Ordinances, State Laws, and Rules and Regulatrons of the San Joaquin such manner sed agents signature certifies the following: "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in ' laws of California." as to become subject t arkmans Co pensation Owner �_ ] - ---------- ------------ '" - -------Signed ------------------- / ( n ---------------------- ----------------------- -- --------------------- -- ---e-------- -- --- - By ----- ------ thr the rFOR DEPARTMENT USE ONLY ' - DATE -------- 30 7f _.- V- - -- - i . ------ DATE ----------------------------- APPLICATION ----i ACCEPTED BY -------------- --------------------------- f) BUILDING PERMIT ISSUED ---------------------------------------------------- -- t 14, '`" --- I9 - ADDITIONAL COMMENTS ----------------------- -- ��--- -- ---- .-. .-. ` ------------ ---------------------------- ------ f- - - --- --------- - I- ----------------------------------------------------------- ------- ----------. --------- MAs - ---Date - - " ------- = �" -. r -------------------------- Final --- - ---- `l _ Final Inspection by: ----- ----- ---- - - d SAN JOAQUIN LOCAL HEALTH DISTRICT F W- 9 1-'68 Rev. 5M -