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AOR OFFICE USE: 6 APPLICATION FOR7SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Triplicate) ................................... .......... 2— Date Issued This Permit Expires I Yeew,From,Date Issued ................------------------------ ------------ clutconstruct. a nd instal! the work herein r Mcd� o he a' =;.co—cal*ki�11-t District for a permit to Application i s" r described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: ' .2482 Cari)enter Rd -------------CENSUS TRACT ------------_---_- I-----------__---------- JOB :ADDRESS/LOCATION -- .24 82 .............. ............k------------ . i ------ Owner's Name ........................ -------------------------------------------------- ---------- Phone .4 - 423-9-------------- Cit 239-------------- ----------- -- _----------- .-. - City ��qpktqn Address --------------------- ...I......... ........... ---------------------_--- : ----------------- ------ ----- -----•............... .......... Contractor's_NarOlackar--d-1 s .Septic Tank .........................License # 268.9.51-------- Phone 463-_?0_4-8_--- I nsta I lotion.WHII-serye: Residences]Apartment House'Fl Commercial E]Trailer Court C1 -Motel [:]Other -------------------------------------------- 4 Number off living units--,.,l..... Num-ber of bedrooms ___.4.__-.Garbage Grinder Lot Size ---2--ker-ed----------------------- Water Supply: Public System and name-----------------------------------------------------------------1...........................................Private K A,; - Clay-Loom.1E] Character of soil to a dept( of 3 feet: Sand'C] Silt 0 Clay E] Peat E] Sandy Loom �E] Hardpan ❑ Adobe ;P Fill Material ------------ if yes,type--------•---------------•-•- (Plot•pidn, ------------ ...... ------- (Plot-pldn, showing size oQt', Iocafion of system in relation to wells, buildings, etc. must be placed on reverse side.) seepage pit permitted if feet,) INSTALLATION: (No septic tank or sebo public sewer is available within 200 feet.0 �k 4"X6'X 101 SEPTIC TANK. Size__.5-------------------------------_----- Liquid Depth ---------5.!_--- ----- PACKAGE TREATMENT ( I SEI I % Capacity ....1600 'Type .5.Q.._.e:------- Matericil.cianar-e.tp- No. Compartments _-_2_z........ y ot 2 .............. Distance to h0arest:,We1150-*..---- ---------------- ----_--------------- Prop. Line...7 LEACHING LINE $) No. of Lines __--2___.-..___�,Tl.ength of each iiiie.-,, ................. Total Length ,..17-Q'............... Filter'Material .....211--------..DepthFilter Material ------1901------- ....................... 'D' Box Type I I I ----------- 15t Distance to nearest: Well -----5Q!...... Property Line ------- -------------- ---- Rock Filled Yes g] No 0 SEEPAGE PIT Depth .___25v-------- Diameter ....i6......11 Number 1. Water Table Depth --- --•-----4D----•---•-- ------------------- ------------------------ Rock Size ...2" Distance to nearest: Well _-__3-00!------•------• ----------Foundation Prop. Lind, .......... REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ................................. Septic Tank (Specify Require ------------ ........................................ ments) .... -------16-QQ...gal----------- - ................... Disposal Field (Specify Requirements) -------------1.70!...Leach—1,1119--&-4---Pit-a ------------- -------------- ........... i ......... -------- -------------------------- iii - ---------------------------------------------------------------------------------------- -------------------------------------------------------------- -------: ---------- ...---------- --------------*--------------I---------I',---(,D--r--a-wlexi-sting and required addition on reverse side) '" I hereby certify that I have prepared this application and that the..work will be, done in accordancii *1th Son Joaquin.owner or licen- County Ordinances, State Laws, and Rules and Regulations of the Son Jo o Joaquin Local Health District. Home sed agents signature certifies the following: "I certify that in the.performance of the work for which this permit is issued, I shall not employ any person in svch...rn.ann*r a to'bee e subject to Workroi s t be subject "0 an's Compensation laws of California." Signe,d - Owner ............ Title -----------------------0-on.tractar.................. .By ---- -----B-113 B-1-acka-rd---------- ------------------------ her than owner) r ORtlf�otar than REPA RMI-N-T)USE ONLY DATE �yi ----------- ---- APPLICATION ACCEPTED-BY. .......i. ......... .... ------ --------DATE ---_------_-_----------- ............ BUILDING PERMIT ISSUED ---- ---•------------------------------------------------------ ... ----------------------............ ADDITIONALCOMMENTS .......... ..........................._------------------------------------------------------------------------------- .:_� •-•-.-..---• _ ........................... _.................................. ----------------------------- I -- --------------- ---- ------------------------- --.-___--_._I-------------- ----------------------------------7----------------------- • ---------------- ..................... • ....i;� _--- ---------....... -2i-2:"-----_----------- ----............................................. ------------- A�I Final Inspection ------ ----------------------7- ..........:............. ----------Date--- --_-------------------------1--------- _p SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'68 Rev. 5M