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,FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .................................... <br /> Permit No. <br /> .......... (Complete in Topumto <br /> ................. ..... This Permit Expires I Year from Dow Issued <br /> Date Issued <br /> Application Is hereby made to the Son Joaquin Local 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 Regulcitionst <br /> JOB ADDRESSAOCATION 9 9 <br /> ..............CO!.... US TRACT .......................... <br /> Owner's Name (144101m,61...... ...............................r.................. . .........Phone .... <br /> J e* . ...... - <br /> Address .,_13. .9p.47.....7. P.V ......................................city .........;-A . ....... ................................... <br /> Contractor's Name _... ...... ................License <br /> .*License# ........................ Phone -----.........._..-_-------.-• <br /> *.................. <br /> Installation will solve: Residence ZI Apartment House J3 Commercial OTrallor Court 0 <br /> Motel0 Other............................................ <br /> Number of living units------------- Number of bedroom* ......._...Garbage Grinder ............ Lot Size ........................................... <br /> Water Supply: Public System and name ... <br /> .......................................................................................................Private 0 <br /> Character of soil to a depth of 3 foots Sand E] Slit 0 Clay G9 Peat 0 Sandy Loom 0 Clay Loom 0 <br /> c. <br /> Hardpan 0 Adobe 0 FIRAcitorfal............If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system In rolation to wells, buildings, etc. must be placed on reverse ski.) <br /> NEW INSTALLATIONt (No septic tank or seepage pit permitted if public sewer is available within 200 feet,( <br /> PACKAGE TREATMENT SEPTIC TANK f00 \rl� <br /> EATM T f ] Size.....: .................... Liquid, Depth ..../...Z........4r, <br /> Capacity .... Type ... . ftMcW..... ..... No. <br /> Compartments <br /> ......... �fir....... <br /> ......? <br /> Distance to nearest: Well ........................... Foundation ... .....*.... Prop. Lim ....70........._. <br /> LEACHING LINE No. of Lines .......),.e....._..... Length of each line... <br /> ..... 1&tal Length ... <br /> V Box ...I........ Type Filter Material ...1_4F..-4eftepth filter Material ..... ..................._7......... <br /> Distance to nearest; Well .....W�-..... Foundation ...2S./........ Property Line .....7A........... <br /> SEEPAGE PIT O Depth -------------------- Diameter ................ Number ............................ Rock Filled Yes [3 No 0 <br /> Water Table Depth ................................................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITI-ON(Prov. Sanitation Permit#........................................... Date ......................L............ <br /> Septic Tank (Specify Requirements) .......... ................ . ........ z <br /> Disposal Field (Specify Req <br /> uirements) ........................... .... <br /> .............................................................................I................................................ ......................................... <br /> ...................... ............ .------.....-_...-----•---- -•---•. ......................................................................................................................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby codify that I have Prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Heald District. Mom* owner or New <br /> sod agents signatur9t certifies the following: <br /> "I codify that in the porformanco of the work for which this permit Is Issued, I shelf not employ any person In such manner <br /> as to b*comA subject to Workman's ;omponsation laws of California." <br /> ..lr <br /> Signed .. . . ....................................... Owner <br /> By .............................. -------------------•--•------•....._..._.........--•• ...... Title ..............._.......... ..................................... <br /> (lf other than owner) <br /> FOWDEPARTMENT SE ONLY <br /> APPLICATION ACCEPTED BY .. Z r <br /> ------ ...... ....... DATE ------ <br /> BUILDING PERMIT ISSUED ........ <br /> ......DATE --- ......................... .............. <br /> ADDITIONAL COMMENTS ------------------------------ .................................................... <br /> ............................. -­------------ ........... .................................................­­..................................................­....... ...................... <br /> .........._---------­---- ....... <br /> .............�I....... ----------.............................................................. -----------............................................ <br /> Final Inspection by: ............. - ----- - - --- ---- ­­ ............... ................. .....................I......Date 11...--•---.... <br /> . . <br /> 13 2 <br /> EH h 1-68 Rev. 5m L <br /> N JOA UIN L HEALTH DISTRICT 8/74 3M <br />