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FOR OFFICE USE. <br /> APPLICATIOWFOR SANITATION PERMIT <br /> ......................... <br /> Q10 (Complete in Triplicate) Permit No-.7)�-..-.... <br /> ......................... <br /> ....... ........-..........I----------- This Permit Expires I Year From Date Issued Date Issued <br /> Application is hereby made. o the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described, This application ii made in compliance with County Ordinance No. 549 and existing Rules and Regulations- <br /> JOB ADDRESS/LOCATION -[...4D.9..N-a,--.Tu.1S.R.............................................. ......... ........CENSUS TRACT ..... ............ <br /> Owner's Name ..... <br /> �dclress --/Sa-m-e <br /> ..... .................................. ......................... .......... Cit ------------ <br /> I A k y <br /> Contractor's Nome ...... ........License # <br /> ----26-8< <br /> �51..... Phone ..... <br /> Installation Residence [2.Apartment House Q Commercial :[:]Trailer Court 0 <br /> Motel E:]Other -,...... ........ <br /> Number of:living units:.. <br /> Number of bedrooms --------Z.Garbage Grinder .......... Lot Size ......... <br /> Lnd name�ir --------------------- <br /> Public N 1�� <br /> Water Supply' Systel itft 9 <br /> -------------------------------------- ................ ....... <br /> Character of sail to a ....... ...Private <br /> depthof3fe�t-. "Sand Silt[:] Clay 0 Pea -E] <br /> -- 4�1 - - <br /> Tt C) Sandy Loam Clay Loam C] <br /> Hardpan ❑ Adobe E3 Fill Material ------------ If yes,type --................--•_ <br /> , sow ------ <br /> (Plot:planhing size of lot, location of system in relation to wells, buildings, etc: must be placed on reverse side.} <br /> f septic <br /> NEW INSTALLATION: (No ttank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT EPTIC TANK Size.... -------------- Liquid Depth .----.11.g <br /> ............. <br /> Capacity ...1-20.0......_ Type ......... Material......4a c6n4ar-etklo- Compartmentsdpi <br /> ..........a___ <br /> S, <br /> DtQ1UF11-t: 50 F d ticon 10' <br /> to nearest: Well .................................... oun a .... Prop. Line ....... 0 <br /> ----------- :Ve .a I <br /> LEACHING LINE t No. of Lines ......Xlktt....1 Length of each line----34A- Total Len ....... <br /> %k 11 th .. <br /> 'D'-Box'l Type Filter Moterial.!!t..-P,!!.........Depth Filter Material ...........;-911..........I........... <br /> Distance fbneorest. Well • ........... .Foundation ..........1-0......... Property Line ....],.a............... <br /> SEEPAGE PIT <br /> De�th ... 2 ....... <br /> -.5- Diameter Number ............I------ ------- Rock Filled Yes No <br /> -4 <br /> W r'l <br /> _.W-ate Table Depth ------------9J51------- ...............!.....Rock Size ....... ..................... <br /> ' !I :"t.4j4�- Il <br /> Distance to nearest.. Well ... .........i0o <br /> ................. .......Foundation ......Q.'......... Prop. Line .......... <br /> REPAIR/ADDITION(Prev. nnit tion Permit# ................... ...... ............. ... Dote ....................... ©-t__--•-,! <br /> . III I I ........... <br /> Septic Tank (Specify Requir" mehts) ........ ............ <br /> Disposalt II, 'Af <br /> . . Field (Specify,Requirements) .... ..... . ..----••-•-----------•------•- -....... <br /> ............... ------------------i------I............................ ....... ..............I..................I............. .................................................................. <br /> .III <br /> ..................................--*------------ -----------------------..................-................................................................................................. <br /> I ' (Draw existing and required addition on reverse side) <br /> t <br /> I 'hereby certify that,I have pr pared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances,"State 'Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or [icon- <br /> seclagents signature certifies the following: <br /> "I certify that in the performance of the work for which this..permit is issued, I shall not employ arty person In such manner <br /> as <br /> to become subject to WoikAan's Compensation laws of California." <br /> Sig'necl ............... <br /> ----------------- --------------------- ------------------------------------- Owner <br /> By ........Z-'*" <br /> ...........................k _2 <br /> .. .... Title .......Cantraat <br /> (if o t h e r ( <br /> �7)-n -0- VV.-. er) ............ .................. <br /> FOR.DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -11- <br /> ......... • DATE <br /> BUILDING PERMIT ISSUED ...... ............. ......... ................ ....................... ...........I ................ DATE ....................................... <br /> ADDITIONAL CO ENT 9.. ......... <br /> 4C 71 A%; --------- <br /> -------- ----- <br /> .............. ------------------- <br /> ........... <br /> .. <br /> - - - . ... . . . <br /> ............ -------------------- ---- <br /> Fin' al Inspection by: .. 1I.......... ...... <br /> - -- .. <br /> . ... .... .......................... ............................ ...................Date <br /> .................... <br /> SAN JOA�QUJN-,�LOCAL.-HtALTH DISTRICT <br /> E. H.-13 24 1-'68 Rev. 5 7 1717 q V <br />