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OFF SANITATION PERMIT 2,, <br />FOR OFFJIKr;E USE: 'Permit NO. <br />.. ... .... <br />FOR APPLICAT10t, FORs's <br />............ (cornpiete in Triplicate) Date Issued <br />...... .. . ........ <br />......... — ......... . ......... ......... This Permit Expires 1 Year From Hate issued <br />t and install the work herein <br />....... for a permit to construct �.Ruies and Regulations' <br />-, is hereby ode to the Son Joaquin Local Health District . 549 and- existl� <br />Application in compliance with County Ordinance Na <br />CE 'TRA <br />described. This application is made, CT <br />)q)z A)p CENSUS <br />A.. <br />j0B Phone <br />oGL .............. I ...... wners Nome City <br />Phone ......... ....... <br />Ad6re. # <br />0 <br />Contractor's Nome . .... .... ­­­ R4 ' si ' den ' ce Qg Apartment Nouse, COr;merc'QI ]Trailer Court <br />Installation will serve: motel 13 Other . .. .. . . .. ..... .............. ........ <br />Lot Size <br />".,Go <br />Garbage Gir;nder <br />Number of bedrooms 4— fba. Private 0 <br />nits:-. u I .... <br />Number of living u name ....... ...... .... ........... <br />Waller Supply: Public System and n Clay 0 , :peat C] Stindy Loarn c Clay Loom <br />character Cf soil to a depth of 3 feet: Sand ;K Silt 0 Y", type 9 <br />Hardpan [I Adobe [D Fill Materialif <br />i - U on,reverse side.) <br />g , et n it be plcitbd � I <br />location of system in r lotion to wells, building 16 within 200 feet,)— <br />of tot, is ovnlli:jb <br />at plan, showing size age pit permitted if public sewer <br />liquid Depth .... .. .. ... ...... <br />(14c, septic tank or seep <br />Size... <br />NEW INSTALLA'tION* ....... <br />PACI<AGE TREATMENT SEPTIC TANK .No. Compartments <br />ty� ors-z— Type f,�A.FA_13 ... material line <br />CapociFounn prop� L <br />nearest; Well <br />Total Length' <br />................. <br />D-Istonceito neare Of ------- ------- <br />No, of Lines Length <br />G UNE t I . io <br />k. Depth r, Filter Mcter <br />LEACHING <br />------- <br />D. Box.-J_ Filter Material property Line <br />_ .. Type $ Foundation /)0 -- V­ 4' , - ' , I <br />Distanceta nearesIt Well illed yes-jg No 0 <br />-Rock F <br />Numbe- <br />Mp.Depth Diameter ....... k. Siz� ------- <br />A& <br />SEEPAGE PIT ��, I....._....._-------J._" ........ <br />Water Table Depth ­­­ ........­ prop. Line ......... . <br />........ :_ ...... Jplundation <br />•Well -­­ ...... <br />Distance to nearestt Date ­­ ...... — ....... <br />N (Prev. Son_,_._., Permit #---------- ­­ .................. ._:1 . ... ........... 1;7'* ------------- ...... <br />REPAIR/ADDITIO <br />.............. <br />Septic. Tank (Specify Requirements) _ ... ..... ................................. . ------- ....... <br />Disposal Field­tSpecifY . Requirements) .............................................. ....... ----------------------- <br />........... <br />............ <br />.......... .......... ­­ .... ...... . ...... <br />......... ... . ................ <br />n reverse side) <br />required addition 0 <br />......• <br />... raw existing....... . �;;� .......in accordance with Son Jo"uln <br />work will be done ritt. Home owner or licon- <br />I hereby certify that I have'prepared this application and that the we 00, utim Local Health t),%t <br />and Regulations of the Son J, q <br />ces, State Laws, and Rules a <br />county Ordintin —1—shfill not employ any person In such manner <br />sed agents signature snaturt cartiflis the following- for which this Pev-'t 's �'s.ued? <br />once of the work f - .1 <br />III-certify that in the perform of ca j ornia./,', <br />ocorpe subleCt to W krnc"'S . Co penza" I ws <br />as to b 111=o whe <br />ie <br />signedT <br />By. <br />")* <br />(if other than ownerFOR DEPARTMENT USE ONLY Z_ <br />DATE — <br />.................. <br />DATE ........... <br />..... ..... <br />APPLICAI;10N ACCEPTED B� <br />BUILDING PERMIT ISSUED ...... ............. .......... <br />ADDITIONAL COMMENTS ..... .. ... . .. ... <br />.......... ...... <br />....... Dote <br />Final Inspection by: 2_ <br />SA y JOAQUIN LOCAL HEALTH DISTRICT <br />r sa o 1-,68 Rev. 5M <br />