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a/ ,•,: FOR OFFICE USE: • ' ;i APPLICATION FOR SANITATION T PERMIPermit No: ./_�'�--- �` '---- ------r�---------- (4o"lete in Triplicate) Fr t - Date Issued----------------------- - _ _ -- This Permit Expires 1 Year From Date Issued PP I A lication is hereby made to he Son/Joaquin cwith CounDtytOrdinance Nom5�49 and existing Rules tand hRegulationsreirt described. This a plication' is madh„��i compliance <• p f 7J .I ----CENSUS TRACT .` �Ili '�.� r 174 JOB ADDRESS/LOCATION ..__--' . ► / /x/l ---------------•-------------- - - _Phone - Owner s Nomej� I /�°I - i41'✓� � -------- Cit Address ;,5 � Q Y rj �'- �M: �(�`} ---License ��Q/------ --. Phone -- -- ------------- -- - Conti ctor's Name ---- --- Residence Apartment House'❑ Commercial :❑Trailer Court ❑ i9 P Installation will serve: � Motel ❑Otlie? . Number of living units:-- s- Number of bedrooms ' --------Garbage GFind'er -__-----___- Lot Size _ ------- 11 -•--- •-----------Private R Water Supply: Public System and name _--- __---- ._w _ -_ .{----„.. � ------ q Chariacter of soil to a depth of 3 fee#: Sand Silt ] Clay [ §— Peat Sandy Loam ❑ m Clay Loa :[ r, � Hardpan ❑ Adobe'❑ Fill Nlaijerial ----Q---- if Yes, type ---------------------------- side.) {P1ot(plan, showing size n of lot, location of system in relation to,plan, buildings, etc. must be placed on reverse i NEW INSTALLATION: (No septic tank or seepa pit per„ mittedjf'Publ,Lr-sewer is available within 200 feet,) /0-- --- Li uid Depth 7- 1 - PACKAGE TREATMENT [,] SEPTIC TANK' i Size._-- -; -- -- q .� '' /x'68� - Types ----- -- Material�t�.�-.a��l,c,No. Compartments �__-__-_, Capacity -- f k \ , F ” S' !. -'r----- Pro Line --- "stance to nearest: Well _-_ __ - _----t------_--•F.oundatio F-------------- p LEAClING LINE o. of Lines..,-:3------;-----.----- Length of each line--- `®�- --- Total Length __-- -®-•---• .Y n `D' Bo Type Filters diol` �'!�--- Depth FiItet Material ru: l/� Mate � Faundation 3` A�- -- Property Line Distance to nearest: Well _ __:_-_- ----- r ;; SEEPAGE PIT [ ] Depth ----- ---------- -- Diameter --_---------—- Number .--1-------------`,-- Rock Filled Yes ❑ No Tr Water Table Depth ------- `----------� --------------------- Line ---------------- 1 Foundation - S; Line ------ --------------- Distance to nearest: Well'-__-.---_ k----------- 4 ------ Date ---------------------------------- --------------- -------------------------------- I � REPAIR/ADDITION(Prev. Sanitation Permit r# -------•------- ---`---- -- � _---_---_•- ,; -- --------- j = ------------------------------------------------ I Se tic Tank (S ecif �Re u�rements) �,-'1 -----------------' ----- p p Y q _, f -------- -- - -- Ey-Requirements t p Dis osal Fie { p eci --- " - - ^------------------ -------------------- __ - -- --------------- g -------a-- --- --- -------------- Draw existing and re uired ad n - --'°-- --'----- - -- -�- ----- dition on-reverse side) [ hereby certify that 1 have prepared this application and the work Will be done in accordance with 5 "Joaquin County Ordinances, State Laws, and Rules and Regulations of the. San Joaquin Local Health District. Home owner or licea- sed agents signature certifies the following: I "I Certify that in the performance of the work for which this permit is issued, I shall not employ any personiin such manner as i to become subject to eWorkman's Compensation laws of California." !. - 4--- Owner Signed --- - -------------- ----------- - - - --- -------- ------ _ Title ----- ------------------ --- --- ------------------------------------ (If other than han owner) it ,E FOR DEPARTMENT USE ONLY. APPLICATION ACCEPTED BY -- *-- _- DATE DATESP . BUILDING PERMIT ISSUED --- `Q{�jS _1RU4Tl. -! � ItV146 -- is -�-� ADDI I NAL COMMENTS ___ =- J -- �� NAL �y 'o- [�y u_nEp_ATr a_n , _ -A�.s-ri r� rE � - ------- - _ _ _ _ ---- -- atm------- -_==�- --------------------- final_lnspec a S O I C L HEALTH DISTRICT ° L? 73 , EI;H-9 1-'68 Rev."M Ih1i� LGi �