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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ..................... permit No. ..� ..G . <br /> (Complete in Triplicate) <br /> .. Date Issued ............... <br /> ... This Permit Expires 1 Year From Dote Issued <br /> Application is hereby made to tk Sah Joaqu n local Health istrict'for a'i5irmit to construct and install the work herein <br /> described. This application is i 1 nce with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..M .:. . ' :... >.a. % ' <br /> 7� L..G.c� ��. ..- ?a-.f.�----•---•-.... :..CENSUS TRACT <br /> Owner's Name ........./../. .......................�................ .�. .... ..one ' , � yam' 3 <br /> Address ................... `? . r . �..� 5�. .................... City ......e . a ?..- ....... ._...........--------........ <br /> Contractor's Name ..A.4.;..a:.. !L: € ` c?v'...-! .:...............License # ......................... <br /> Phone <br /> Installation will serve: Residence Apartment House] Commercial oTroiler Court0 <br /> ,,++ Motel ❑Other............................................ <br /> Number of living units:.....1....... Number of bedrooms .A ....Garbo a Grinder Lot Size ................... <br /> or­­---` <br /> ................ <br /> Water Supply: Public System and name .................................................................... .. <br /> _ ........................................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loom 0 Clay Loam 61► <br /> Hardpan a Adobe V� fill Materlal ............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: ( <br /> No septic tank or seepage .pit permitted if public sewer is available within 200 feet,) `v <br /> PACKAGE TREATMENT ( ] SEPTIC TANK e..,,.,:..:.......... <br /> Q �,. � `��,�C, �� .............. Liquid Depth �.."�.i�......... <br /> Capacity 1.C1�?.0..... Type J.:+�--... fi Material k u ...... No. Compartments .. .............. <br /> Distance to nearest: Well <br /> -...•..!� ........................' Foundation ...... Prop. Line ....` <br /> �:4'.V........ <br /> IVLEACHING LINE No. of Lines ..-.-t,�J�............... Length of each line........n"r"........... Total Len Length f <br /> '0' Box .... ...... Type Filter Material �z ....Depth Filter Material ....f r........�__........_ <br /> Distance to nearest: Well 3.n ............ Foundation ..... 3 ........... Property Line ............. o <br /> SEEPAGE PIT ` Depth ... .......... Diameter Z7Z.4fj ..... Number .....�....... S k Filled Yes No 0 <br /> f <br /> Water Table Depth .. s� ..: ............................Rock Size .... y.`::'...Z........... <br /> Distance to nearest: Well %.;?. '..'`.....................Foundation ... :.� .'...... Prop. Line ..�'�.�..'f............ T <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ............................................ Date ..................................j <br /> SepticTank (Specify Requirements) ........................................................................................................................._................. <br /> Disposal Field (Specify Requirements) .................................................................................................•................................... <br /> ....---•---•------••....................................................................................................................................•---................--•-.......................... <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 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 performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to become subjeo to Workman's mpensation Inn of California." <br /> Signed .. .•,i�`'1 � ... ?VL h... ..�...�! r� <br /> BY .................................. •-•-••. .....: `� ..... . <br /> (If other than owner) -- - ---�............. title ....�:�.... . � l <br /> WOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ....... .. DATE .,.'. ..c.Z,.,...... . <br /> f.................................. .. ................. <br /> BUILDING PERMIT ISSUED .............................. .........................................................................DATE ..................................................... <br /> ADDITIONALADDITIONAL COMMENTS .............................................................................................................................................................. <br /> ................................................................................................................................................................................... <br /> FinalInspection b....,-_:... .....•-..-7..-•- ........................................................................................................... ...�. ................... <br /> Py: ' .Z� ..................................................Date .1�.., � ................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> c_u 13 24 <br />