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FOROFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------ ......JA.J.j--...... (Complete In Triplicate) Permit No. <br /> ............. .................. <br /> Date Issued <br /> ................ <br /> This Permit Expires I Year From Date Issued <br /> -----------6...... <br /> Application is hereby mode to ttie'Son-Joaquin Local-,Health..District for a permit�to construct <br /> s-t'r�yct and install the work herein <br /> described. This application is made in"Compliance iojh"Cooniy-OHinan6�Nor�- 549'-ariii,eMsting Rules and Regulations: <br /> J_ .....................CENSUS TRACT �---------- .............. <br /> JOB ADDRESS/LOCATION ........ ............... <br /> C-1 T / I . ......Phone .................................... <br /> Owner's Name ................. .............. ...... --­---------------2�.................... . <br /> "ell <br /> se # %R.7/ .... one _I---W., <br /> Ph r=� ...... . <br /> ------ ..... City;, ----------------- ..................... <br /> Address <br /> 1 ...........Lice <br /> Contractor's Name . <br /> Installation will serve: Residence-- 3 partment House t3 Commerciq�[-)Trailer Court 0 <br /> Motel Q Other ... .............. ------------- <br /> Number of living units Number of bedrooms ...Z-----Garbage Grincler',7(,,e,e.4 Lot Size ................. <br /> .....Privat <br /> WaterSupply: Public SystL-m and name .........................--------_----- ............. ............ ......................... <br /> S �O <br /> Character of soil to a depth of.3 feet: . Sand 0 Silt E) Clay 0 Peat C]r Sandy Loom [I Clay Loom @Et'— <br /> Hardpan E], Adobe 0 Fill Material If yes,type ---------r-.............. <br /> (Plot plan, showing size of lot, location of <br /> f system in 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 /> PACKAGE TREATMENT SEPTIC TANK . ...•----.. .•.._... <br /> .....__...... Liquid Depth ....... <br /> Type1�1-�_. o. Compartments ...................... <br /> . ........... <br /> --------------__ Prop. Line <br /> Diston�!to nearest Well ........ <br /> gth ......... 0 <br /> LEACHING LINE No. of_Line�i Length of each ........ ... Total Len <br /> 'D' Box Type Filter Material 47--------Depth Filter Material ... <br /> I JLine .............. <br /> Distance'to n6arest- Wel-I _J0---------- ...... Foundation " ......... Property <br /> Number No C3 <br /> ............ Rock Filled Yes ff,� <br /> SEEPAGE PIT Depth ...... Diameter 3' 0,- <br /> .1 Jr I ------ rn <br /> Water Table',Depth _..--..:4C7.__-- ----------------------------Rock Size <br /> Distance to nearest: Well --------Foundation Prop. Line ...A - -------C� <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ... --------------------- ------ --- Date __---------------------_-------•I <br /> Septic Tank [Specify Requirements) .'7Z1----_------------_................ -------- ............... ----------------- ............. ........... ........_............... <br /> Disposal FieldSpecify Requirements) :.1-----I ......7'*--.. -------........................... <br /> --- <br /> 7; ................... .................... <br /> ---------- ...... ........ . ............. <br /> ..........I—_............. P <br /> ............ .............. -------­-------------­.................. .. ........ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in 'accordance with Son Joaquin <br /> County Ordinances, State Laws,and Rules and Regulations of the Son Joaquin Local Health District. Home owner at licen- <br /> sed agents signature certifies the following: , I shall not employ any person in such manner <br /> "I certify that in the performance of The work for which this permit is issued <br /> as to become subject to Workman's Corripensation laws of California." <br /> Signed ........ -------------------- ------------------ Owner <br /> - -- ---------- --- J_ . ....... <br /> --------- ...... Title .............. <br /> By .. . .......... ................ . <br /> (if"oth r <br /> t an owner) <br /> FOR DEPARTMENT USE ONLY <br /> TE............. ..................... DA 1117.'7 ..... ---------------I <br /> APPLICATION ACCEPTED 8 ....DATE ............. ------------- --------- <br /> BUILDING PERMIT ISSUED ...... ........................................... ................. ........ <br /> ADDITIONALCOMMENTS -------- -------- ----------------------------------------------:-1-1-----------­....... ....................... ......1-•----...---...•..... <br /> .................... ..........................-......... <br /> ----- --------------------*--------------- <br /> -------------------- ... ..... -------_----------_ -------- ------ <br /> -------------- ......... .................. <br /> ------_---------- ............ .. ----- ----- - ------ ...... . ..........-1.......... ...............1-1................ <br /> ............... <br /> ------------ ---- --- ...... <br /> -------------- --------- ...... ... ........ <br /> .4 .............bate .......... <br /> Final Inspection by: . ...................... ..... ------ -------- -- -- --- ----- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 77 4''L <br /> c u 13 24 z.—An g?-- rm 12 4' <br />