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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> ........................................................ Permit No. .,7 <br /> (Complete In Triplicate) ----------- <br /> ............... <br /> S <br /> .......... ........ ................. This Permit Expires I Year From Dot*Issued Date Issued <br /> Application is hereby mode to the San Joaquin Local Health District for a permit to,-construct and Install the work herein <br /> described. This application is ma a i!l-compliance with,County Ordinance No. 549 'and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION ............. <br /> ...........................CENSUS TRACT ............. <br /> Owner's NameZIAVIj L----- ...F,-4 .........:................Phone ...... <br /> Address --------------------------------- ------ --- ------- ......................­1............city ....................................... <br /> Contractor's Name --- W.....2�=�!!-4.r...............................License # _627%6221.. Phone <br /> Installation will serve: Residence[]Apartment Houseo Commercial-STraller Court 0 <br /> Motel []Other.............. ..................I-------- <br /> Number of living units;_.Aff... Number of bedrooms A/0....'_Garbqge Grinder Lot Size .......... <br /> Water Supply. Public System and name .......... .........................I...............................................Private❑ <br /> Character of soil to a depth of 3 feet. Sand 0 Silt❑ Clay 0 Peat 0 Sandy Loam 0 Clay Loam 0 <br /> Hardpan E] Adobe In Fill M6teriol ............ if yet,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 seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT fj SEPTIC TANK{ ] _----------- Liquid Depth ....d..e............... <br /> Capacity -4- 20101- Type 4401(5&k Material No. Compartments ....... <br /> Distance.to nearest: Well -----A10 ..................Foundation ........... Prop. Line ,............ <br /> T <br /> LEACHING LINE No. of Lines ------- -------- Length of each line-----440 0 <br /> ........... Total Length ......... <br /> er <br /> V Box .._/___.. Type-Filter Material ItA' X 'A'o <br /> i <br /> ..Depth Filter Material .... ........................... <br /> '13;;t i or <br /> Distance to nearest, Well Foundation ----- ............ Property Line .06..............� <br /> SEEPAGE PIT, (11 Depth -.04AW60.'....... Diameter Number .._-/.................... Rock Filled Yes)' No (:] <br /> Water To'ble Depth ........ ......­1............................-Rock Size ....... <br /> A <br /> Distance to neo I rest: Well ---- ...... ...............Foundation Prop. Line <br /> REPAIR/ADDITIONIPrev. Sanitation Perrnit# ..........__------------_------_--.... Date ..................................I <br /> Septic Tank (Specify Requirements).......-•-- ........ ...................... ...........I........................................... <br /> ....................................... ...... <br /> Disposal 'Field" (Specify Requirements) ------ .............. ....................................... ...................................................... ............... <br /> ............I-------------------------------------- ...... ----------- -------------------- ......... ................ ..................... .............. ........................ <br /> ------------------------­1------------­----------- ----------------------------- ...... ........ ...........­­...................................... .................. ...... <br /> ­­.......... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with'San Joi6quin <br /> County Ordinances, State Laws, and Mules and Regulations of the San Joaquin Local Health,011strict. Home owner. or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work far which this permit is Issued, I shall not employ any person In such manner <br /> stobecome sy i to Workman'I <br /> o;"pensafi-on :aws of California." <br /> Signe -------- -- - --------- .................. Owner <br /> BY --------------------------------------------------------- -------------------- -----------------•- J'tle <br /> ......................... <br /> lif other than owner) <br /> fOjt DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED SY ---- --- -- ----•------------------------ ---------- DATE ...... <br /> BUILDING PERMIT ISSUED ------------ ....... -------------------- -,.DATE ... .................. ........... <br /> ADDITIONAL COMMENTS .... ---- --------------- -------/DATE .... ... <br /> ---------- ----------------------- ----------- --------- -,-7-1--------------------------------- <br /> ------------ . ......... --------- -------------- <br /> ---------------••------._.._-..------=-•------------- <br /> ----------------------___-------6__----------- .... -------­­ - ------- --------- - ------ -_ -------- , <br /> --------- ----------- ------I- ---------- <br /> -------------------_-- -------------­.1..... ... ---- --------- --------------................. . ........ ---------------------------------- <br /> . ........... <br /> Final Inspection by: ------_----_----- ..... . ..----.._....._..-•--••---••--•• <br /> ......................­------------------ --------------------Date ...... -- ------------- ------ <br /> ---- <br /> EH 13 2h 1-68 Rev'• 0 IN LOC, <br /> 5%M SAN J/AU N LOCAL HEALTH DISTRICT 8/7h 3M <br />