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FOR OFFICE USE: H <br /> APPLICATION FOR SANITATION PERMIT <br /> _------------ .........................................- Per it No. . <br /> (Complete In Triplicate) <br /> Do <br /> .......... This Permit Expires I Year Frown Data-issued, <br /> Application is-h-ereby-made-to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> 6scribed. This application Is rqd In compliance with County Ordinance No. 549 and existing Rules and Reaulationst <br /> &I L,6 <br /> RESS/LOCATION TRACT ............ ............ <br /> jeM!1V................r........ <br /> Own .........Phone S <br /> ....... ........ City .. ' <br /> -----­-------- ----------- j ............. .............. <br /> • Address <br /> Contractor's Name _._wcac....... ................_". •----........license # . ...... ...... Phone <br /> Installation will serve. il Resident Vg Apartment House 0 Commercial OTrailer Court C) <br /> MotelOther ................. .......................... <br /> Number of living units:--- ------ Number of bedrooms- ------.!-.__Garbage Gfincler ------0... Lot Size .....?Aaffj.................. <br /> Water Supply- Public System and name ......... Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay [3 Peat 0 Sandy Loam 0 Clay Loam 0 <br /> Hardpan Adober <br /> Fill Material .VC5. if yes,type <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT I ] SEPTIC TANK te size......)2P.n----------- A....... Liquid Depth ............... <br /> 2 1'Z................... <br /> Capacity .... Type -AP9,C&IMaterial...aq_VAaJ6o. Compartments --- <br /> Distance to nearest: Well ..........Foundation ..... Prop. Line <br /> LEACHING LINE No. of Lines _.__....I. _ .. Length of each line._--.-.C7 ............ Total Length. ..........• <br /> 10. Box Type Filter Materjcll,�,5e --- <br /> pO.j_TA I Depth Filter Material . ......................... <br /> Distance to nearest: Well<gbaX Foundation ....... Property Line ...1� X....... <br /> SEEPAGE PIT , Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No 0 <br /> Water Table Depth ................................................Rock Size ................. ........... <br /> Distance to nearest; Well ....................................... Foundation .-----_---------_ Prop. Line _--------_------_ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --_---_------------_----- ............ <br /> Date ................................. <br /> SepticTank (Specify Requirements) ............................................................... ....... ........................................ ................ <br /> Disposal ,Field (Specifi Requirements) ---------------------------------------------------- .............­........................................... ....... <br /> --------------------------------------------------------------- ----------------------------------------------------------------•---- --•-•••-- ................. .......... ................ <br /> ii <br /> ..._.... .. \ <br /> ------------------------- ------------------------------------------------------------------------I------------------------------ ................. ....................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and'that the work will he done in accordance with Son Joaquin <br /> County Ordinances, Stof97 Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner at licew <br /> sed.agents signature certifies the following- <br /> ' <br /> "I certify that in the performance of the work for which this permit Is Issued, I sholl not employ any person In such manner <br /> as to become s !act Tr ,non's Corpensation laws of California." <br /> Owner <br /> Signed NO az . ....V \----_-----_-------_----- <br /> By _------------------------------ ------------- ....... ------__­-----­----­----------- Title ......... ----------_------------------- .......... --------- <br /> (if other than owner) <br /> FORDEPARTMENT USE ONLY <br /> APPLICATION ACCEPTEDjBY .._..1�Y_1._­ ------ .......... 1 <br /> .-•-------------------------------------DATE ....... -------; <br /> BUILDING PERMIT ISSUED ---------71.. l_/;Z ..._D TE...:._ .......... -------- <br /> .......... <br /> MENTS <br /> ADDITIONAL CQr <br /> stltc ...................... ........... ....................................... ----------- _------------ <br /> ...J., <br /> ........................ ... ------ -------- ----------- ....... <br /> ------------------ --------- <br /> 7 <br /> -3------------- <br /> ............. .............. --- ------- ----- ------------*-------------------- <br /> -------------------­----- - -- - ----- ------------------------- __­, <br /> - ---- -- ------ ....................... ......... <br /> .................................. Da _. ...-•-----• ------- ..................... <br /> final Inspection by: <br /> EH 13 24 1-68 Rev. . 5M SAN J AQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />