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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PIEWIT <br /> Pernilt No. <br /> ......... 1Corrp1&to in Triplicate) <br /> "'a......................... ... D. .. -e issje6 .1. ....y/-e <br /> This Permit Expires I Year From Date Issued <br /> Application it,hereby Made to the Son Toa .uin Local Health DilliriCit for a permit to constrijitt and instcjli the work here;n <br /> described, This V-ppliCation is made in compliance with County Ord'nante No. 549 and existing Wes and Reg"TiOr%s: <br /> ,08 ADD -....CENSUS TRACT . . ................ <br /> RESSAOCAVON <br /> Owner's Ncnle _h2v ...... .......... .... .... .. .......Phone ......... <br /> ........................ City ------------- ----------------- -- -- <br /> phone 4 <br /> d;; cense <br /> . ..................... <br /> con'tractor s Narne Commercial FiTraller Court <br /> lnsto*%otion will serve. Residence �, artrrent HouseO <br /> motelmothe'- ........ ...... <br /> 'urrbe- of bodrom, .,.7 V.(;., Lot Size -Zo- <br /> Number of living unitsi.-L-_ N . ,,-.-,.Ga;JD4qge Grinder Private ;_4 <br /> wate, Supply. Public System and ri,=e —------------------------­------------ ----- ........ <br /> Sc.rtd 0 Slit C Clay Loam <br /> Clay <br /> Chcrocrer af&oil too,depth o4:3 -eet- pectt S,-nciy Loor <br /> Hardpan Adobee-o Pili Moterial If yes,type <br /> 10 wells. buildings, et;. must be placed on reverse side-1 <br /> I plar., owint size of lot. location Of system in relation; <br /> NEW INSTALLATION., (No septic tank or seepage pit permitted If public tower is available within 200 feetJ <br /> PACKAGE TRE.ATMENT it 'I SEPTIC TANK Liquid Depth <br /> - S .............. <br /> Mater-101 No. COMPO"Ment <br /> Capacity Type undatim YJ9. '. Prap. Line <br /> Distance to ne.a'rest: Welf ........ . .. . .......... <br /> Total Length <br /> EACHING LINE le <br /> No, of Lines Length *f each *line, ter Mweecl ........ <br /> *D' Box Y" <br /> Type Filter,.Material /P�Z-Ct<--DL-Pth F" <br /> . .. roundation . ...... Pro <br /> pedy Line _-_:_ ..... <br /> D'slorice to nearest. Well .... .. .... <br /> Rock Filled Yes 7. No C <br /> SEEPACE PIT Depth ...... ............ Diameter Number ....«........._... <br /> Wiater Toble Dep+ _................. Size ----------------------------- <br /> DIsTonce to reores*, Vvell ........­............-Jounclation PICO. tins <br /> REPAiRl"ADDITION(Prev, Sollltcti011 Pefrr.11,* ............._ Data ...............___.......... <br /> Septic Tank jSpec!,;y Requirements) ---------I............................. ....... <br /> Disposal Field (Specify Requtrernenttl, . ...... <br /> ........... .................................. ... .......o ....... ...... ... <br /> ,D.-cw ex sting rd required cdc!"'loncinVIVersc, <br /> I - accordance with Son Joaquin <br /> I hereby certify that I have prepared this appiicctiori and that tars work wilt be do" In <br /> County Ordinances, Stato laws, and Rules and Regulc"ns of the Son Joaquin Local Health District. Home Owner or fit*n- <br /> sod o9omis signature certifies the following- it I ss,4eid, I Shoji not employ any person in such Manner <br /> -I rectify that in the performance Of the work for which this Pem <br /> r <br /> or, to betorrio subject to WorUman's Compeniscition laws Of CdI!f0fni`­ <br /> Z,grea� I .............. ............................. ....... <br /> av ....... ........I....... ....................... lifle ..... .. ....... <br /> other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> ...... DATE <br /> APPLICATION ACCEPTED 8 ........... <br /> DATE .............. <br /> BUILDING PERMIT ISSUED <br /> ADDITIONAL COMMENTS — ...... ........ ............ .. ...... <br /> ins ion t;v- D <br /> J t--- Vie. L <br /> 4 DISTRICT <br /> SAN JOAQUIN LOCAL HEALT, hdid ,OUt 't-ylk <br /> 117 ev"d <br /> lze'vii. SM 70r e,* <br /> Qzjor oct <br />