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FOR OFFICE USE: <br /> APPLICATION FOR SANIYATION PERMIT <br /> ............. <br /> ......... (Complete in.Triplicate) Permit <br /> 6 <br /> ...... ......I.............. ......... This Permit Expires I Year from Date Issued Doti Issued ...6......02....... <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 mode In compliance wl unty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ........ ...................CENSUS TRACT .......................... <br /> Owner's Name D .......... ...................__......................phone ...............•---..............._.• - <br /> _16A_�_ _Z__ <br /> Address ..... ............ <br /> . .................. .. .......city I.......................­............................ ........ ............ <br /> License- <br /> Contractor's Name .........*------- Phone <br /> Installation will serve, Residence 0 Apartment House 0 Commercial OTraller Court C] <br /> Motel0 Other............................................ <br /> Number of living units:_ -- Numbe.r of 'bed rooms ---;��...Garbc!ge Grinder ............ Lot Size ze .............. <br /> • <br /> Water Supply. Public Systim and name .........................------ .................... .......................................................Private0. � <br /> Character of soil to a depth of 3 feet: Sand 0 silt IJ Clay [3 Peat 0 Sandy Clay Loam o <br /> Hardpan El Adobe 0 Fill Material ............if yes,type............................ <br /> (Plot plan, showing size 161f lot, location of system In rotation to wells, <br /> y buildings, etc. must be placed an reverse slde.J <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,! <br /> PACKAGE TREATMENT SEPTIC TANTO Size <br /> .............. Liquid. Depth ._.4......... <br /> c6pocity e Material.....4-- ---- No. Compartments ...... <br /> TYP ------- <br /> Distance.to nearest: Well ...................................:Foundation ...................... Prop. Line ----- <br /> . 1� ................. <br /> LEACHING LINE, Nb. of Lines ......!§_�------------- Length of each line_._..f.JP...I.............. Total Length ...,/..X'0.........__.. <br /> ............ <br /> V Box ............ Type Filter Material ....................Depth filter Material .............­............................. <br /> Distance to nearest; Well ........................ Foundation ................ ....... Property Line ........................ <br /> 11. 02 <br /> SEEPAGE PIT Diameter ..-------------- Number .......r ...... ............ Rock Filled Yes No C] <br /> VA'ter Table Depth .......................................... ....Rock Size ...... . .................. <br /> Distance to nearest: Well .......................................Foundation ­.................. Prop. Line .... ................. <br /> REPAIRADDITION(Prev. Sanitation Permit# ............................... <br /> -------- Date ---_. <br /> Septic Tank (Specify Requirements) ... ----------------------------------- <br /> .............................. ..................o.............................. <br /> Disposal Field (Specify, ...Re.quirements) .--•--••-•----------- ----11.......I............_...................................­.............................I............... <br /> --------------- __­....................... -------------------- .......­­......;...............................I——....... ..............I......... <br /> ............ -------- --------­-----1-1'__----------­------11---------------------------------------------- <br /> ------------- -------------------*...........*...... ............................. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I har. 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 or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the perfor6ance of the work for'which this :permit Is Issued, I shall not employ any pe on In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed <br /> 7'M <br /> --- .... ..... ................. Owner <br /> By ... .... --------------------- Yitle ---•-...-----------------•..... ......... <br /> ------ -- --- -- - - ................ .......... <br /> (if at er thane own r) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEDBy r "e- DATE 6-OLLA ...IG <br /> ........ ....... <br /> .... ............ <br /> BUILDING PERMIT I!SSUE0,.A ........................................................ ----DATE .. ................................... <br /> ADDITIONAL COMMENTS !F___._.._.-._-.._....- <br /> ........................................ <br /> ------------- ------*------------------------ -------------_---------------•*...... <br /> - ------------------------&....... ....... <br /> ----------- ............................I-------------- ----------_- -------------------------- ---------I---------------- ...................... <br /> ........... -------- ------------ - - - --------- ..................I.......I.................. <br /> Final Inspection by: ------ t... .... ---------------- <br /> EH13 2h 1-68 ........ .............__.................I-------------­--- ---------m............_.......Date ..... .......... ......._............... <br /> 5H SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />