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FOR OFFICE USE: <br /> .................................. ........I........... APPLICATION I FOR SANITATION PERMIT 7J? <br /> (Complete In TApilcate) I Perm ...... <br />..........I......I..................................... <br /> This Permit Expires I Year From Daw Issued <br /> Date <br /> ......................................................... <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 existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ......�t....................................... ...CENSUS TRACT ..6.1&.T......... <br /> Owner's Name ------------ .... .. ......... ....... ... . ....... .. . ......Phone V6.2...------------------------_ <br /> Address ............... v. city ............................... <br /> . ............................ ........ .......License <br /> Contractor's Name ....... ------ 4 <br /> Phone li -------- <br /> _907 <br /> Installation will serve-I Residence Apartment House 0 Commercial OTraller Court 0 <br /> Motel 0 Other................ ............................ I <br /> Number of living unhsh-!,._.._h.e. Number of bedrooms .._)e.-.._Garbc!ge Grinder Size ...... .............. <br /> Water Supply. Public System add name .... ........................................... ........ ..... Private 0. <br /> ............ <br /> Character of soil to a depth of 3 feel: Sand 0 silt 0 C16-y 10 Peat 0, Sandy Loom 0 CI V Loam 0 <br /> Hardpan r! Adobe Fill 'allcllk6........... If yes,type............ ............... <br /> (Plot plan, showing size of lotAlocation of system In relation to wells,[buildings, etc, must be pliced on reverse slde.) <br /> NEW INSTALLATION: (No,sept"h1cJ-1t#d-n`k�'or seepage pit permitted if public sewer is available within 260 feet) <br /> PACKAGE TREATMENT SEPTIC TANK Size...............1:.............................. Liquid Depth ....................... <br /> Copocity__------- Type .................... Material. ------- No�—Compofiments ........__....... <br /> Distance to nearest: Well ..... ...................... ....................... Prop. Line ...................... <br /> LEACHING LINE No. f Lines ........................ Length of each. line.. ...... ......... Total Length .......... ................... <br /> D Ii0o x ............ Type Filter Material ....... ---Depth Filter Material ......................... ......... <br /> Distln_ce to nearest: Well ........................lFoundation --------- Property Line ................ ()o <br /> SEEPAGE PIT De pth A................. Diameter ................. Number ....................... Rock Filled Yes 0 N <br /> Water Table Depth _..............................i7i.......Rock Size ..................1'. <br /> Distance10 nearest:zWell ---- Foundation .......... ........ Prop. Line ................. <br /> );11�1- - ---------*----------***......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...­..................... -------------- <br /> -7.......... <br /> Septic Tank (Specify Requirements) ............. ..... --------------------­- --••---------------------­---- <br /> ------------ ---- ---- ..... <br /> Disposal Field (Specify Requirements) .............. ...•--------..._:........... -- <br /> --------------------­----- - <br /> --------------------------- ----J---------_-------- ............ --------- .......... ........................ <br /> ...........41�_.33 <br /> --------------------------------------------------- <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 <br /> with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of We Son Joaquin Local Health,,Distritt."Home owner or 111cen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is Issu <br /> ed, haif not"employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ----------:------------ -- <br /> ----------­- ........ ................ Owner <br /> . ......._.............................. Title .... ...... .........t <br /> BY ---------------------------- <br /> (If of er than owner) -------------------- <br /> t <br /> FOR DEOARTMEINT,US"NLY, <br /> APPLICATION ACCEPTED BY -----------------------------•-.._... DATE ......57-5-5-7 ------------- <br /> -4 <br /> BUILDING PERMIT ISSUED .... ............................. <br /> ..... . ..................DATE .............I---------------- ............ <br /> ADDITIONAL COMMENTS ----- --------•---.-._...-•------................ ................... <br /> I i t�, L/ <br /> ------------------------------ --------------------------1-11-------------------------------- --------- ------- ---------- ------------------------- ----------------------------------------------- <br /> ------------------------ -------- -------------------I-------­---------­----------- -----------I--­------------_1--------------_.__........................... ............... <br /> ------------------------------------- --------------------------------------- --- ................................... ----------- ................. <br /> FinalInspection by, .--------------------_-----_........................... ......... ............... ...__- -----Date ----------------- <br /> EH 13 .24 1-68 Riay. 5M SAN JOAQUIN LOCAL HEALTH DI 8/74 3m <br />