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-FOR QFFICE USE. <br /> J APPLICATION FOR SANITATION PERMIT 5 )6 <br /> ............. ------------------ - (Complete in Triplic9btel Permit No. -7-z=5--------- <br /> , ---- <br /> .1 - - ;7 T_ <br /> - - -------- -- <br /> ------------------- -------------------------- -- This.Permit Expi res 1 Year From Date Issued Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for 01permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION _77V-----&j_4��u!� -----44ez---------------------- --------------------CENSUS TRACT -------------------------- <br /> Owner's Name ---/ e�.�_ ---------4e-----e5�elqk,!4--_5�------------------------------------------------------------------------Phone _Y7-?-------9,r_ryO <br /> Address 4-—----- -----------------------I--------- -------------------------------------- <br /> -- city ---------------------------------------- <br /> Contractor's Name ------- __S_,e;fP---------------------------------License # /2"753"3-_ Phone <br /> Installation will serve: Residence [ij Apartment House,E] Commercial :E]Trailer Court 0 <br /> Motel F-1 Other -------------- ---------------------------- <br /> Number of living units ------ Number of bedrooms _2-----Garbc�ge Grinder Lot Size <br /> Water Supply: Public System and name --------------------------------------------------------------------------------------------------------------Private F] <br /> Character of soil to a depth of 3 feet: Sand'E] Silt E] Clay [] Peat E] Sandy Loom [], Clay,Loam,-0 <br /> Hardpan E] Adobe� Fill Material ------------ If yes, type ---------------------------- <br /> �-(Plot plan, showing size of lot, "location of system';'!n relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> r -, -i <br /> 'SEPTIC TANK --------------- <br /> PACKAGE TREATMENT Size.__ ___11Y�r--- ------------------ Liquid Depth <br /> C PC <br /> a C yl,,26� pe -;?6r Mat'Jrial_G� �No. Compartments a-G----------------- <br /> W -------------- Foundation _14�.............. Prop. Line- __________._.___ <br /> ------------ <br /> Distance to nearest. Well ---3---------- - ------ <br /> LEACHING LINE No. of Lines ------r7?-------------- Lengthof each Iine.__1'5___f------------- Total Length <br /> 'D' Box Type Filter Material ----Depth Filter Material -------------- <br /> Distance to nearest. Well -------—---------------- Foundation ------------------------ Property Line -5... ............. <br /> SEEPAGE PIT Depth Diameter ----------------- Number ------2---------------------- Rock Filled Yes No 0 <br /> r i e /_/ '(f le- <br /> Water Table Depth _�-- ------------------------------;........Rock Size X/------------- <br /> 1 41 <br /> 3 <br /> Distance to nearest: Well _�------- ----------------------Foundation _Z0- .1 <br /> ------------ Prop. Line .... .11 <br /> T <br /> I _ I <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------- ------J---------------------------- Date --------_-------_--- ---------- <br /> SepticTank (Specify Requirements) -7------------------------------------------------------------------------------------------------------------ ----------------------- <br /> Disposal Field (Specify Requirements) ---------- -------------- ------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------:------------------------m--------------------------t---------------------------------------------------------------------------------------- <br /> --------- ----------- ------- ------- ----------------------------------------------------------------------------------------------------------------------------------------------- --------------------- <br /> (Draw existing and required,64clition on reverse side) <br /> I hereby certify thatI have prepared this application and that the work wili be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and ROes and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the Following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subject to rkman' om0ensationj9ws of California." y . <br /> Signed ----------------------- ------------- -- - --- --------------I L,------------—---------. Owner <br /> By ----------------- ----------- -----*------ - -----------------------------Tit ---------­--------- ----------------------------------------------- <br /> (if of r. than ner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .. - - - DATE ---- <br /> -B--U--I-L--D--I-N---G-----P-E--R--M---IT----I-S-.-S--U--E--D--f-------------- ----------- <br /> -------------- ----------- ---- - - -w----------- TE"-- -e---- -7- <br /> ADDITIONAL COMMENTSr -- - - ------------------------------------------------------------------ <br /> - <br /> - <br /> - <br /> ------------------------------------------------------------------------------------------------I........----------------1--- - - --------------- --------- - -- ----- <br /> ------------------- <br /> ------------------------------ ---- -- -------------------- ------------- - ---- <br /> -------------Date <br /> Final Inspection by: -- -- - - --- ------- -------------- <br /> ------------------ <br /> ----------- <br /> -_�SAN JOAQUIN LOCAL HEALTH, DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M <br />