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FOR OFFICE USE, I "I 61;: 1. � <br /> --------------- APPLICATION FOR SANITATION PERMIT <br /> (Complete In Triplicate$ Permit No. 2......... <br /> .. ....... . <br /> ..................I........_................. <br /> ............. .......4......... Doti Issued 7.. <br /> This Permit Expires I Year From Date Issued ............... <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 opplicatiori is made in compliance with County Ordinance No'. 549 and existing Rules and Regulations: <br /> I . alZ�s- I <br /> 108 ADDRESS/LOCATION!, ........ __ . '--..."._......-S........• a--ca-je.......-..CENSUS TRACT <br /> .......................... <br /> Owner's Name <br /> ............................. ............ ...... <br /> Address . ................................. <br /> ...... -------------- city Phone <br /> Contractor's Nome ... <br /> �.License # Phone ...c,.46-6- <br /> Installation will serve. Residence 0 Apartment House 0 Commercial oTraller Court <br /> S." <br /> Motel El Other..-- <br /> Number of living units:_._..':: Number of bedrooms -Garbage Grinder ............ Lot Size ...4' . <br /> Water Supply: Public Systern' and name ................................................... ..................................._.-..............Private <br /> Character of soil to a depth.,f 3 feet. Sand El Silt Clay 0 Peat[:] Sandy Loom�• Clay Loam <br /> Hardpan 0 Adobe 0 Fill M6 <br /> aterial ............ If yes,type ............... ............ <br /> abP <br /> Mot pian, showing size ';lot, Ioc6iion-6f­_system In'rehition to wells, buildings, etc. must be placed an reverse side.1 <br /> N <br /> NEW INSTALLATION: IN '. septic tank or seepage pit permitted if public sewer is available within 200 feetj <br /> PACKAGE TREATMENT ( I SEPTIC TANK f <br /> Size--------- 7...... ........... ...... Liquid Depth ---------- .............. <br /> -.1 1 _S7-1A" Capacity --------_--------- Type .................... Material -------------------- No. Compartments ..-------.........--.• <br /> Distance.to nearest: Well ....................................Foundation ...................... Prop. Line ................... ... <br /> LEACHING LINE-. Nol of Lines ......../*-----------. Length of each line..... _-57-0..........I- Total Length .... ......... <br /> V ox Type Filter Material /-;Z ............Depth Filter -MdtefIal ............. ................. <br /> D-11st nce,to,nearest:t: Well ............. Foundation Property Line <br /> p <br /> of <br /> Of Li <br /> r <br /> L <br /> B 4ewc <br /> SEEPAGE PI- , De IL- --------- brameter Number ......./.................. Rock Filled Yes,n- No ❑ <br /> j Wader Table-Depth ............ ........Rock Sizert-�-z__ri�_ <br /> ,,Distance to`nearest: Well _0,0 ........................Foundation .... ...... .... Prop. Line ...... <br /> A. <br /> REPAIR/ADDITION — .. _,,� ; ,) _", , <br /> ITION(Prev. Sanitation ��rrr;it W ­............ Date ... - I <br /> .............. ------ .... ................ <br /> Se'96Y*64:-ISpqcify Requo em,entsj.,_n_:.. ........... ................................. .............. <br /> Disposal Field (SP-ecify ------- <br /> equiremen <br /> ----------=------- <br /> ......... ----- .......... ......... ............................... <br /> - ------------­-- --- ----------_------------- ...................V..........__.................... ................... ............................. ................. <br /> (Draw existiri4AWd- re—quired'&ddltloKon reverse side) <br /> V hereby certify that I have prepared this application and that the work.,will`be)dome In accordance with San Joaquin <br /> County Ordinances, State L Ws, and Rules and Regulations of the Son Jociqulh Local Health,Disfrict. Home owner or-licen. <br /> sed agents signature certifies�iiie following: <br /> All certify that In the perfo <br /> rmance of the work for which this permit is issued, Ushall not employ any person In such manner <br /> C.S to become sub! ct t War"man's C mpensation laws of California.- <br /> Signed <br /> Owner <br /> P <br /> By -- - . -- -- ---------- ------------------------------------------- -Title <br /> (I other than owner <br /> FOR DEPARTMENT <br /> APPLICATION ACCEPTED BYI _.-----_ <br /> ---------- <br /> --- ----- <br /> --------- <br /> BUILDING-PERMIT-ISSUED77,------ <br /> ..DATE ....................... --------- <br /> ADM0 . <br /> DITIONAL COMENTS ........ ................ ........ <br /> ....... <br /> . ........... ................. ....... ........ <br /> ............... ------------ -------- <br /> -------­----------- ------- ------------------------------- ----------­---------•.................................................................... <br /> --_------------;- <br /> ------------ <br /> ----------------------------------------- ---------------------------------------------------6........ - ------------------------*-------­------ .......... ...................... ........... <br /> Final Inspection by: ...---- ---r----*......... 11.*.-.-.-.-.--- 11-1-1----1--------I----------------_----- ------ - ­ , ----------� '6a'-t4 e------- ---2--,(---................... ....---- <br /> *...... II <br /> EH 13 2h 1-68 liev. I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 3M <br />