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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ...... .................. Permit No. 2/:77,7 <br /> ) <br /> ........................ <br /> (Complete in Triplicate <br /> .:nz7 <br /> ...................... ........ .............. This Permit Expires I Year From Date Issued Date Issued ... ...... <br /> -Application is hereby made to the Son Joaquin Local Health District for a permit to tons uct 'and install the work herein <br /> � C-t <br /> described. This application is mode in compliance with County Ordinance No. 549 and existing Rules and Regulations., <br /> JOB ADDRESS/LOC.AFION,_;.L.PA. .......er---AVwy ....... TRACT .......................... <br /> Owner's Nome ................................... . ...........Phone <br /> q-Zr....... ------ :.........:......... Phone <br /> Contractor's Nome -A­W-J�-10 -------- -------- ------------------------ _...---.License # __.................. Phone .............................. <br /> 1: ' I <br /> Instollatio6—wl will serve: Residence ❑ Apartment House-[] Commercial [-]Trailer Court <br /> Motel 0 Other _...... ...................... <br /> Numbir'of,living' units:..... ---- Number of bedrooms- _Garbage Grinder ------- ..... Lot Size 06 ......-­....... <br /> Water Supply: Public System and name ......................... ­­___--------_-------__..........................Private <br /> Character of soil to a depth of 3 feet: Sand F] Silt F) Clay El Peat E) Sandy Loom F] Clay Loom 0 <br /> Hardpan E] Adobe C] Fill Material ..,,.......� If yes, type ........ .... .............. <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 seepa e pit permitted if public sewer is available within 200 feet,) _/ <br /> PACKAGE TREATMENT SEPTIC TANK e................. ........ ....... Liquid Depth ...... <br /> rloll No. Compartments ------2�......... <br /> Capocit 6rr)- -------- Type <br /> YA <br /> Distance to nearest- Well .............. ...Foundation ..... .....­­ Prop. Line <br /> LEACHING LINE No. of Lines Length of each- line /1/0_ Total Length ................. in <br /> T <br /> 'D' Box ype Filter M61teria Depth Filter Material ..../1/-,0,. .........................7- <br /> --------... Found .......... :k. !! <br /> Distance to nearest: Well .....Y-0 Foundation &4------ ..... . . Prope rty Line <br /> SEEPAGE 'PIT [ j t <br /> .Depth Diameter ---------------- Number . . ......... Rock Filled Yes 0 No 0 <br /> J-1 Water Table. Depth .-------- -_ -- ..............................Rock Size ...... <br /> Distance to nearest: Well � . . ........--._--....._..._.__._...Foundation <br /> ........ ....... Prop. Line ...................... x <br /> i <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ...........-1...............­­­­... Date r.........!......t�....... <br /> Septic Tank <br /> JS0ecify Requirements) .. <br /> ­ - ------- ------------------ h..._...... ............... <br /> �isposal Field (Specify Requirements) ......... ----------_----------- ------- <br /> . .... .............. <br /> , I A t � �/ I � <br /> .......---^--------------------------.. ........­­................... ..............­------- ......................... .. . ...... ...................... <br /> ...................... ........... .......­_..___ ----- 1 ........ ........... ............ <br /> (Draw existing and required addition on reverse side) <br /> I hereby'certify that'IKa-4e-prepared'this applicationandthat the -work 'Will '." clone in accordance with Son Joaquin <br /> County-Ordinances,' State Laws, and Rules and Regulations of the Sarrjo`04uin Local Health District. Home owner or licen- <br /> sed agents 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 become 5 ect to Workman's�mpensation low of California." <br /> Signd - ... . . ...... <br /> -- Ow <br /> ierr .. .. ... <br /> By ... -------- <br /> . ......... ...... <br /> Title ...... .... .... ...... <br /> ----------- ------------ - -- <br /> Ilf other than owner) <br /> -,R.DEPARXMENT USE ONLY <br /> APPLICATION ACCEPTED BY "k,y DATE .. P. ------------- <br /> BUILDING PERMIT ISSUED ..... .. .... <br /> ...... ...._DATE ........ ....... <br /> ADDITIONAL COMMENTS ..... . ... <br /> ..........­:-------r-........ ........ ........................... :...................• .............. <br /> ........... <br /> ...................•-------.--•.1-..1...-. - .. .... .I.... -- ---- )Ov <br /> -- -----.-.-.-.- <br /> ........... -I..._............ ....... ... <br /> .....................................-.-.-.-.-.-.-.-. <br /> . . . ......� . _ ­­....... <br /> Final Inspection by: ... ... - --- o -- - <br /> ........ ...................Date ------(J - _ - <br /> SAN JOAQUIN LOCAL HEALTH- DISTRICT <br /> 13 24 <br />