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FOR OFFICE uset <br /> . - - I— APPLICATION FOR SANITATION PERMIT <br /> ..............I......................I........ .. permItNo. ..7 . <br /> 1� <br /> lComplefolnTriplIcatel . . . <br /> ................................................... <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 construct and install the work heroin <br /> described. This application Is made in compliance with County Ordinance No. 549 and existing Rules and Regulations= <br /> JOB ADDRESS/LOCATION .....&d............................................CENSUS TRACT ........................... <br /> Owner's Name ............. 47. �X...................... ...Y.. x.................................................Phone Cal <br /> Address ...............S.A.A'A.c......... ............ City <br /> .............................................. . .X86.......f14........................................ <br /> %Contractor's Name -.-k..... ev Z ZA n/Y9 .......................License # ... phone <br /> installation will servo3 Residence M Apartment House 0 Commercial[]Trailer Court C) <br /> Motel (:)Other--_--------------- ----------------- <br /> Number of living units:------�_. Number of bedrooms ---/.....Garbage Grinder ............ Lot Size ?e-,�............I. <br /> Water Supply, Public System and name .........................•--....-__---.....--....-- ................................................ ......private In <br /> Character of soil to depth of 3 feet, Sand 13 SlItEl Cloyo Peato Sandy loam O Clay LaamlM <br /> Hardpono "Adobe o FIlIM6torlal............ If yes,typei. <br /> ............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,),, <br /> PACKAGE TREATMENT I SEPTIC TANK( I Size................................................ Liquid Depth ........................... <br /> Capacity ..................... Type ..................... Material..........._......... No. Compartments ..................... <br /> Distance to nearest. Well' .............•................... Foundation -_--------_--------- Prop. Line ...................... <br /> LEACHING LINE No. of Lines ........................ Length of each line................... ..... Total Length ............................Oq <br /> D' Box -_-------- Type Filter Material ........ ............Depth Filter Material ....I........................................00 <br /> Distance to nearest. Well ...... ........ Foundation ......................... Prop" 'Line ......................... <br /> SEEPAGE PIT, Depth .................... Diameter ................. Number ........ ................... Rock Filled Yes 0 No Uj <br /> Water Table Depth -------------------------------------- .........Rock Size ................................ <br /> Distance to nearest: Well ................ .......................Foundation .................... Prop. Lino ..•.••--.--•---------4 <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ........................................... D ...................... . I <br /> Septic Tank (Specify Requirements) ................... ...................................f/_1 ----------- ...................................... <br /> Disposal Field (Specify Requirements( ....... Tei• Ye C/ <br /> .........................................*.................*..................................••-•------ <br /> .**"***'*'*......­­.................. <br /> A/ <br /> .................................I...........................................Ift.......................I................... ....... .......................................... <br /> ............................................................................ .......................................................... <br /> -- - - ---- ------------- - .. ...... <br /> (Draw exist'ing"o-nd'required*add*lti'o'n'on-"ireverso'sl'de*)" <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 subject to Workman's Compensation laws of California." <br /> Signed .... ... g<i ..... ....................................... Owner <br /> By ....... .. .... ................. ..................................... title ................................................. ...... ..... . <br /> (if other than owner) <br /> JOR DEP 6VMEN:F_Y)E ONLY <br /> APPLICATIONACCEPTED BY ...................... DATE.. <br /> � ,4A.e4%. Cd44_... <br /> BUILDINGPERMIT ISSUED .....—---------- ......... ......................... --------------------------------------------DATE __..................... .................. <br /> ADDITIONALCOMMENTS .......................... ...... ---------------------------------- ........................................... ..........i...................... <br /> ..........­..................;...............................................................W............. .........­......-1.......I.................. .......................... <br /> .........................................:... ... ................................. ..........................................*­­...........*.......... ... .................. ........ ...... <br /> Final ..... . . ..............................Date ..7-............ <br /> ­ -Inspection-a'_n---b­Y__:------.............. .. <br /> EH 13 2h 1-60 Rev. 5M SAN JOAQUIN LOCAL- HEALTH DISTRICT 6/7h 3M <br />