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POR OFFICE USE: FOR SANITATION PERMIT <br /> ......... ......... ........... Permit No. 7��....... ....... <br /> (Complete In Triplicate) <br /> Dote Issued ............. <br />............... ............. This Permit Expires I Your from Date Issued— <br /> the 5on Joaquin loco A <br /> Application is hereby made to ; I 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 /> US <br /> JOB ADDRESS/LOCATION TRACT ............... <br /> F <br /> Owner's Name VIM <br /> Address ....... P- a w- .--e-.---....---------..._-....---- ............city ­-.�no .. .. ...... ---------------- ........... <br /> Contractor's Name ------------------------------------------- # .........I............... Phone .............. ------------- <br /> installation will serve: Residence 0.Apartment House Commercial Iler court 0 <br /> Mote!C1 biker .....—..................................... N. <br /> Number of living units:............ Number of bedrooms ............Garbage Grinder ------------ Lot Size ...... <br /> Water Supply.. Public System and name ------- ----------- ------ ............ ........................... ...............................PrivateA. 4*4 <br /> Character of soft to a depth of 3 feet, Sand El Silt 0 aay-O� " Peat 0 Sandy Loam {K clay Loom o <br /> .1-lardparesdo Adobe 0 Fill Material ............ If yes,type............... .. <br /> 1. <br /> (Plot plan, showing size of lot, location of 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 f I Size..... --- Liquid Depth .......................... <br /> Capacityj966------- Tyl)4; No. Compartments ....�A?,-�, <br /> ............ <br /> Distance to.nearest: Well ...... .:.............:.Foundation ..... ................ Prop. Line ........... <br /> 7......... <br /> LEACHING LINE No. of Lines .-..__.if............... Length of each line -7. Total Length ---- 7............ <br /> I <br /> D, Box ------- Type Filter Material_-��-."I�VDepth filter Material ... ......................... <br /> Distance to nearest: Well 1�'. Foundation ------ ................. Property Line ........................ <br /> SC4-W L <br /> Depth .............. lXmeter 11.)(.2?---- Number ....../......... ......... Rock Filled Yes, No 0 <br /> A <br /> 9)(/z I Water Table Depth ......................:t=—...............Rock SizeZ... ....... <br /> Distance to nearest: Well ... ....................rounclation .................... Prop. Line ................. <br /> REPAIR/ADDITION lPrev.,Sanitation.Permit# --i....................................... Date ......... ......................... <br /> Septictank (Specify Requirements) ------------------------------ ---------------------- ......................r .................................................. <br /> Disposal Field (Specify Requirements) ............................................................................................................ ............... <br /> ............................—------------------------:--------- ................... ........ .............. ....... ............ ........................................... <br /> ----------- --------- ----------------------- ----------------------------- ...............-.................................................... ...... <br /> (Draw existing and required addition an 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 Joacluirm Local HealthrDistrict. Home miner or Ilcen- <br /> ,,wilisecl aginits signature certifies the following: <br /> "I certify that In the performance of the work for which this permit Is Issued, I shall not employ any person In such manner <br /> as to becomeblect to Workman's Co <br /> jp ns!!!on laws of California." <br /> Signed .......................... Owner <br /> By ........... -------------------------------------------------------------------------------------------- Title ----------- .................................................. <br /> (If other than owner) <br /> DEPOMTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ... .... ... ----- ------- -----....-----....--.-•---•--.-...-----------.. DATE .................... <br /> BUILDING PERMIT <br /> ---------------*----------------I-S--S-U---E--D-------------"I'll----- ---------------------------------- ------- <br /> .,_DATE ................. <br /> ADDITIONAL COMMENTS �e-2 - .... . ft� .-.. <br /> --- - --------- ----------------- ----------------------------- <br /> ------------------- ------- ------------ ------- --------••---------•---------- -------- ----------------------- ------ -—---------------------------------------- <br /> -------------------------------- ---------------------------------------------- .....----•• --------------- . ...... ------------------------- <br /> Final Inspection by. <br /> --- -- ------------------- ------- ........-...... .......................... ......-Dat( <br /> 01- - .................. <br /> EH 13 2b 1-68 Rev. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7b 3M <br />