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?%M uerlLt Whet <br /> APPLICATION FOR SANITATION PERMIT <br /> .................. ...... ......................... <br /> lCompleW In Triplicate) Permit Nci. .7�.......? <br /> ................................... <br /> 77 Dote <br /> ................................... .... This Perrnit Expires I Year From Date Issued <br /> J: <br /> t. <br /> 1. <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application Is made In compliance with County Ordinance No. 549 and. O' xlstlng Rule's and Regulations, <br /> JOB ADDRESS/LOCATION ......... .......CENSUS TRACT <br /> Owner's Name ... ...........................................................................Phone.: ....... <br /> Address ......7 l...*h"y......................................................city ...40: .'w.................2....................................... <br /> Contractor's Name ...4Z2&4v!Ve .. ................................................. ------License # ........................ Phone ............................. <br /> Installation will serve, Residence JKApartment House a Commercial OTroller 4burt 0 <br /> Motel 0 Other....../.&!�Aa4w <br /> r. <br /> Number of living Number of bedrooms 4.......Garbo ge Grinder Lot Size ...........1. <br /> Water Supply, Public System aii-cl name ................................ <br /> ...........................................................................Private <br /> Character of soil to a depth of 3 feet. Sand E] Slit 0 Clay 0 Peat C3 Sandy Lwmpf Clay LOOM E3 <br /> a . <br /> Hardpan Adobe 0 Fill M6terlol ............ If yes,type............... ............ . <br /> IPI at-plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATIONs, INO septic tank or seepage pit permitted If public sewer is available within 200 feet] <br /> PACKAGE TREATMENT SEPTIC TANK[ ] Size....._` _,P0 --- Liquid Depth ........................... ... <br /> capacity ... Type 0 <br /> Material7 a. Compartments <br /> 4 <br /> &A/,4&V?jV Distance to neafest: Well ...................Foundation Prop. Line --S_!1..... .....A <br /> LEACHING LINE No. of Lines ...1!�4---- .......... Length of each line.......w..,f............ Two(Length A ................... <br /> V Box .../...... Type Filter Material IA.72_14i."pth Filter Material .................. <br /> ;r <br /> r; e///'"j <br /> Distance to nearest: Wall Apo!........ Foundation ......... Property Lino ......... <br /> ................... <br /> .77 <br /> we Uhl <br /> ................................................Itack fllwr�/. ............. . <br /> .. .. <br /> ................. ........ ......7.......... <br /> REPAIR/ADDITION JProv. Sanitation Permit# ............................................-Date...... .. ................ <br /> SepticTank (Specify Requirementsl ..................... ...---...a....... ........................ ................ .................................. <br /> W - <br /> Disposal Field JSpeclN RequiremeWst _--------- vlp�_ <br /> ----- -----------I................................. .......................I............. <br /> ........................................ .............•.... ...............t......................... ...................................................................�:t....................... ...... <br /> .......................................................... ......................... ........... <br /> .......... ........... . -------------­­------------- ----- <br /> rever- <br /> ( F a <br /> Draw existing 4��j required addition 6'n go side) <br /> I hereby certify that I have prepared this application and t"t the work will be clone In accordance with Son JoacluT,�: :1 <br /> County-Ordinances, State Laws, and Rules and Regulations of the-Son Joaquin-Local Health District. Home owner or Ilcen­'A�l <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is Issued, I shalnote ploy any person In such manner <br /> as to beco e Subilmd t or man 4 Compensqjion laws of California." <br /> Signed) ......................... Owner <br /> BY ........ ....... ... ..'Title ....................................... ......... .................. <br /> Iif of or v or <br /> r owner) <br /> MR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..... ........................ ............................. DA T Er/Z I�...................... <br /> BUILDING PERMIT ISSUED .......... ...DATE........--......... .. ....... <br /> ALC QMME _4 <br /> N T S 3,t� X.e,0. <br /> ................ ..................... <br /> ---------------- ............ <br /> .........................­­...... ...... ....... .......­­...... <br /> . ................­;;wi�..... . ....... .... . .. ...............................*............ ------------ <br /> ............... ........ . ......................... .... ....... . .. ..................... <br /> Final Inspection ....... <br /> ..................... ................ Date ...................... <br /> EH 13 24 1-68 V. <br /> �4 SAN JOAQUIN LOCAL HEALTH DISTRICT 3M <br />