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FOP OFFICE USE: _ APPLICATION Fog-SANITATION PERMIT Permit No. 7L` - �\ (Complete in Triplici te'l—F -------- ------------- --------------------------------- --- - - -- �� I Date issued - -- -- -=- - _ This Permit Expires 1 Year From Date Issue ----- ------------------- ----------- -- V<// ' ith County Ordinance No. 549 and existing Rules and Regulations: Application is hereby made to the an Joaquin Lc c W Health District for a permit to construct and install the work herein: Pp desra'ibed.-This-application.�m;�e� com rad-� � . ,. l 7 ------ --------- ----- -------------------- CENSUS TRACT -------------------------- JOB ADDRESS/LOCATION - ----------•------- i Phone ----------------------- ------------- !`A� = T1 -31--------------------- Owner s Ndine _-.- } Cit � V-0- City ------------------ Address ----------- '. ------.License # -------- : Pone Contractor's Name`;---;' ' �� ' installation will serve: , Residence partment House'❑ Commercial []Trailer Court k❑ P1/ yl, NGlPy i Motel ❑Other ----------------r-------- I7 / / _Garbage Grinder ----------- Cot Size, Number of`living units:-----"--- -- Number of r Private [I , Water Supply: Public System and name _--- 'Sandy Loam ❑ Clay Loam Clay ❑ Character of soil to a depth of 3 feet: Sand silt a Peat❑ Y e Silt C Hardpan ❑ Fill Material ___._----- - if es,typ lot Ian, showing size of lot, location of system in relation to ells, buildin s, .etc. must be placed on reverse side.) (P P I it ermine if ublic s is available within 200 feet,) NEW INSTALLATION: (No se tF Siz p is tank o\seepage p p -. Liquid Depth ------- J-�'` P � PACKAGE,TREATMENT I SEPTIC TANK, , ,�,- ,?�a a ia1- a --�r,,No. Compartments "------ t Capa tY TYP ! ~ Z Q Prop. Line - ` YDi ante to nearest: Well "_ _ Fou at' n _--_-- - -- / f Total -Length Q ------ ea line-- --------- f _____ •Len th ' LEACHING LINE / o. of Lines - - ria ----- - ;. . - epth l t _ Filter 'M to -- --•� - -- �f- D' Box' -- - TYpe�Filter at r.�a* :_ n ' `,� Property s, Li e. ------------ -- j ---- -- ------- Fund on Distance,to nearest: ell \ er um V _ Rock Filled Yes No ❑ S AGE PI , Depth � Di m t r e r�Y-- Water Table ept ----- ---- Q = !� DistanceLnPZ�# est: ell ---------------- - - --_- -- -Fol ndation ---- Prop. Line ' ,} ------------ -- n ----- '- ate REPAIR/AD ITION rev. Sanitati --------- - „� -_----------------•s 11r ' - Septic T�nk l ecify Requirements) - - - ------ y r- ------------------- '..L1 -` Dispos I Field (Specify.Rere ents) ----------- - U✓C- �.'L -----------------I-------------- ------•-- _ .- li ___ __ _________ ____________"_______ w ----- -----"---------' --"---- -----'--•--- -"--- _ .--..--r-- .-- ",.�....� ' - ----------------------------------------------------------------'---- ---------- ------ --- ----------------------- ------ ----------- ired - - (Draw existing and re wired adds-ion on r'ever a side) ne in I hereby certify a prepared this application a d th at the wo,ot the S n Joaquin Local oHealth DistrtltnHomece 'towner or 1 cenh Son - County Ordinances, State Laws, and Rules and Regulati ns ,- sed agents signature certifies the following: � issued, I shall not employ any person in such manner "I certify that in the performance of t r \ Eich th 's permit s s as to becodie sub' eo W'.1 L ' � -w---s---o--f-----a---l-i- forn'a." Ow ner - =t / ---Signed lit e --- ---------- ---- -- - ------,--- ------ -- ------ (if other than owner) ` T USE ONLY _ R TMEN DATE - rb k --------- -=--------- - --------------------- ---- . --------------------------------------------------- --- --- DATE APPLICATION ACCEPTED BYE__.__---'`-- _, _ ____________________-------- BUILDING __ BUILDING PERMIT ISSUED ---.-'------- - ---- - --- --- - i ---- ------ ADDITIONAL COMMENTS = 4 F _1__________________________ r _.____"______ _--------------------------------------- ------------ ---------- Date - - Final Inspection by: --------------- i v SAN JOAQUIN LOCAL- HEALTH DISTRICT F'H-0 r,.:n :_1-<'68 Rev: 5M _