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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PeRMIT <br /> .......... <br /> (Complete In Triplicate) <br /> Permit No. <br /> .................. ................................ te <br /> ....... This Permit Expires I Year from,Date.lisved Date Issued �:.V <br /> Application is hereby made to the Son Joaquin Local Health District f pert to construct and Install the work heroin <br /> described. this application is made in compliance with County Ordinanic"o. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ....... <br /> ..............I........ .......................CENSUS TRACT ... .......... <br /> Owner's Name .............I.............. ................I....................phone ....4.16.31ZA, q- <br /> Address ...........__[_77 ;;.L. <br /> .. _6_E <br /> .............. <br /> .................. <br /> Contractor's Name ..._H-(A)-102W-AlZ­S�F_� ..................i1c'ense.i-O..Y�Tol phone <br /> Installation will serve: Residence Vg Apartment House 0 Commercial OTraller Court C] <br /> Motel []Other ............ <br /> ............. ............ <br /> Number of living units:----._-__- Number of bedrooms .......3....Garbage Grinder ......... Lot Size .....�...UAE....................... <br /> Water Supply. Public System and name • ............................................ ....... ................._........................Priya <br /> to Q <br /> Character of soil to a depth of 3 fee. Sand 0 Silt 0 Clay Q Piaio__4 Sandy Loom C3 Clay Loom 0 <br /> Hardpan❑ Adobe 0 Fill M6terlal ............ if yes,type ............... ............. <br /> (Plot plan, showing size of lot, location of system In relation 'to wells, buildings, etc. must be placed an reverse side;) <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer Is available within 200 feet,} <br /> PACKAGE TREATMENT SEPTIC TANK Size........E P.- k..._.....- Liquid Depth <br /> 7 ..................j <br /> Capacity _------ ........;­ Type ---------------_-- Material <br /> ...................... No. Compartments :.X.._....:.....-9. <br /> Distance to nearest. Well ..../_Q.0.....................Foundation ..LQ............. Prop. Line ..Li.xi............ <br /> LEACHING LINE No. of Lines ----- --_------------. Length of each line..------------_-.......... Total Length ......................... <br /> V Box .......... e filter-Material <br /> T6, ...................Depth filter Material .....­­................................. <br /> YOU se -ro Oe Distance to nearest: Well`:.:../.;' ' ....s?.._'_ .... Foundation ....I_z2_/ Property Line ...L4.0. ......... <br /> 3 <br /> SEEPAGE PIT _5� <br /> Depth - -Q. --------_---- Diameter 3A..q....',Number ................. Rock Filled Yes )n No. <br /> Water Table Depth ........I........................................Rock Size .......... ------ <br /> .:Distance to nearest: Well ..........................Foundation -2347............ Prop. Line -'(!4.... ....... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........... ........................... Date ...................... .............. <br /> Septic Tank (Specify Requirements) ---- ...................................I..........: .............. <br /> .......................... <br /> Disposal field (Specify Requirements) ............. ............................................ <br /> ............... ................. ...................... <br /> .................... .............. ........................................ ....... ....... ------------------------------------------------------------........... <br /> -------------------------- ........ --------------------------------------------- ------------ <br /> -------- ............. ------------------------------ ........................................ <br /> g­ required addition on-t-eveirse side) <br /> JDraw existing an <br /> I hereby certify that I have prepared this application and that the wd4k. will be done In accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the 'San lbacluln Local HOOW District. Home owner or licen- <br /> sed.agents signature certifies the following: 7 <br /> "I certify that in the performance of the work for which this permit Is Issued, I shelf not employ ani person in such manner <br /> as to become s"ct to Workman's Compensation laws of California.."' j i <br /> Signed ......... -------- �er, <br /> --------- - ------ ...... Ow, <br /> By .... ........................ <br /> ----------------------------- ---------------- --------- ................ .................... ----------- .......... <br /> (If other than owner) <br /> DEPARTMENT USE ONLY <br /> 11 0 <br /> . ............. <br /> -- --_ ........ <br /> APPLICATION ACCEPTED BY ------ -- - ------ -- ............ ... .........DATE J <br /> - ------ ---- ­.- .?J.......... <br /> BUILDING PERMIT ISSUED _............... --------- . ............. ............. ----- ----- ------- ... ----------DATE .......................•----......--•---.. <br /> ADDITIONAL COMMENTS ---------------------­---- <br /> ­­ -­-----­---------------- <br /> ----------- <br /> -_ ------ ............... ................­....................... <br /> ---------------------------- <br /> ................. ----------------- ----------- -----------­----- <br /> -----------_-----_--._..................... ..................... <br /> ..................... . ....; — I <br /> .. ..... ... <br /> -- ----------- <br /> .............. ------------Date <br /> Final Inspection by: ----- ----- <br /> EH 13 24 1-68 V- 5M ...... - ----------------------------------------------------- _775 <br /> SAN J AQUIN LOCAL HEALTH DISTRICT 8/7h 3H <br />