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FOR OFFICE USE: <br /> APPLICATION FOP. SANITATION PERMIT <br /> ...... ........................... Permit No. .7!��.......... <br /> (Complete in Triplicate) <br /> ............. <br /> This Permit Expires I Year From Date Issued Date Issued A/ <br /> ........... <br /> Application is hereby made to the Son Joaquin Local Health District for a per'mit to construct and install the work herein <br /> described. This application, is mode in compliance with County Ordinance No, 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION <br /> � . ....... <br /> .. ..........CENSUS TRACT ................. ........... <br /> Owner's m r . .... ....... ..... ............... .. . ......Phone.............. . . <br /> ..... <br /> Address­.._:_'..'N1Z�__ ..e—-_-_ .. ..... ..... ...... ............... ...... City ............ .............. ............. ................ <br /> -Phone ............... ....... ...... <br /> Cdpfractor'i Ndhid ... ... ................ .......License # ----- ----------- <br /> Installation:will serve- Residen,ce Apartment,House 0 Commercial�[:]Trailer Court 0 <br /> motel n Other .......... ...... <br /> ............. <br /> � <br /> Ndm.b r of living units:--- .......;Number of.bedrooms <br /> !�; 9 <br /> ..Garba 'e Grinder ............ Lot Size ...... ......................... ........... <br /> . <br /> Water Supply: Public SyAtem and na(me, -­-------­-------------- .........................................Private,0 <br /> Character of soil to a depth of 3 feet:' Sand:E] r,,Silt 171 Clay C] Pe'dt[3 Sandy Loom 0 Cloy Loom <br /> Hardpan 0 A&166 ,C] Fill M' teriol ............ If yes, ...................... <br /> type ...... <br /> (Plot plan, ,showing size of lot,. Iocbtion� Of,sysiern 'in relation to wells, buildings, etc. must be placed on ieverse side.) <br /> NEW INSTALLATION: (No�l septic tank or,seepage pit permitted,if public,sewer is available within 200 <br /> PACKAGE TREATMENT SEPTIC TANK J ] '_Size.. .................. Liquid Depth ................... ......I <br /> � <br /> Capacity ........ Type ..............'Material......... ............. No. iComportments ... ....... <br /> t <br /> Distance to� neares Well ............... ...... ,:.._...Foundation ...... ......... ..... Prop. Line ......1.............. <br /> LEACHING LINE No. of Lines .................. .......I Length,of each line...._......._.. ..... Total Length ....... .......... <br /> -D' Box ..... ...... Type Filter Material: ...Depth Filter Material .................................... ....... <br /> Distance to 'nearest:Vell ........................ Foundation ......................... Property Line ............... ......... <br /> SEEPAGE PIT Depth ......._1.......... Diameter ................. Number ............................ Rock Filled Yes M 140 C] <br /> Water Table Depth ......................... ...................Rock Size ........... ...................... <br /> Distance to nearest. Well .......... .....................Foundation --- ........ <br /> .................... Prop. Line ....... --- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .................... .................... Date .................................. <br /> Se Tank (Specify ReqUire 'ents) .... <br /> ptic m ...... ........L ...... <br /> ------------- ............ <br /> Disposal Field (Specify Requirements) .... . . ...... ........ ....... ...................... <br /> L <br /> t_..... . ..... i ..a. tie.;.........0....... ..................................................... ..................... <br /> ......................................... ............................. ................................... ........................ ............................. ---------------- ------ ...... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have,preparedp this a' plication 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 Health District. Horni*i owner or ficen.' <br /> sed agents signature certifies the,followirig, <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 becom ub1 t to W rkmaC" ompen-s"on laws of Californim <br /> Signed <br /> .... ......................... ..... Owner <br /> By ,.................... ....... Title <br /> ...... ..... .................... ....... .................. ................... .............. <br /> ............. <br /> (if other than owner) <br /> T USE ONLY <br /> FOR DEMRTMEN <br /> 5: ........................... <br /> . .... ..................... DATE ... ............ <br /> APPLICATION ACCEPTED BY......... .. <br /> .............. ............... ............. .......................... <br /> BUILDING PERMIT ISSUED .................. ............................... .... .... .........DATE <br /> ADDITIONAL COMMENTS .. ........:.............. ...... ......:...... <br /> ......................... ....................................... ......... .................. <br /> ........... . . . .................................. ...... ..................................7................... ...... ....... .................................. ................ <br /> . <br /> ................ <br /> I ... ... <br /> ......... . .. <br /> Final Inspection:by. .. . ............................................... ................................................................................................................................. <br /> ......D..a..t..e.............Z............................................................... <br /> ;..7.... <br /> ............... <br /> :SAN,,JOA IN .'LOCAL HEALTH: DISTRICT <br /> 13 24 I.-AR 7172 3-M <br />