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FOR OFFICE USE. APPLICATION FOR SANITATION PERMIT <br /> ............. ........--------------------------------- 77- 7" <br /> Permit No. ..................... <br /> (Com pleto in Triplicate) <br /> This PermitExpire: I Year From Date Issued Date Issued _7��72.- <br /> ................. .....A........... <br /> Application is hereby made to the Son Joaquin Local Health District for a permit <br /> mit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No, 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCATION 6.1........81s.H. ...........................CENSUS TRACT .......................... <br /> ... <br /> Owner's Name -.o hMW75 ....... ...........-•---.........•...... .....................phone <br /> Address ........... .......401311�7e.4:7..- city Y�29_y......... ......... <br /> L :2 9 <br /> Contractor's Name ........ ... Phone <br /> Installation will serve; Residence4 Apartment House C) Commercial OTraller Court 0 <br /> Motel 0 Other............................................ <br /> Number of living units:... ...... Number of bedrooms .../......Garbage Grinder /YD..- Lot Size ..................14 <br /> Water Supply: Public rn and name .................................i_............ ........................I.......... ........................Private <br /> Character of soil to a depth of 3 feet. Sand I-] Silt E] .- dicy [) Peat 0 Sandy Loam={] ' Clay Loom 0 <br /> Hardpan Adobe X. Fill Material ............ 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: (No septic tank or seep <br /> .,qge pit permitted If public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT I ] SEPTIC TANK,I/) Size___....................................... Liquid Depth ......................... <br /> Capacity Type -.'7............... Material---------------------- No. Compartments . ............. <br /> Distance 1-6-neorest. Well <br /> ........ ...................Foundation ...................... Prop. Line .................. <br /> LEACHING LINE No. of lines .F_-_.•:.....:........... Length of each line............................ Total Length ............................ <br /> D' Box ............ Type Filtei.Material ....................De pth Filter Material ............................................ <br /> Distance to nearest: Weil ........... .. ........ Foundation .................. Property Line ........................ <br /> t <br /> SEEPAGE PIT Depth ---- ._------ Diameter ._......L...... Number ...... ......... Rock Filled Yes [3 No (31 <br /> Water Table Depth -----_-----------------4-------_------------Rock Size ................................. <br /> Distance to nearest- Well ....................... ............Foundation --------------..­_ Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permfit-#---.- <br /> .................. Date ............ .............. <br /> ,.,SAptic.Tonk_(Specif.V Req6firet�iiihfs).................. <br /> ------------I-------------- .....................­.­................. ........... ---------------------- <br /> Disposal Field (Specify ----------- ...... ...... <br /> _V <br /> ,,�4e ........e <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 Rulespand.Retfularioni of the Sian Joaquin Local Heal&DIstrict. Home owner or licen- <br /> sed agents signature codifies the follhiwinij: ..'. - . 4" tw � r <br /> "I certify that in the performance of the work iorvAlch thili-permlils.issued:11. shall-not employ any person In such manner <br /> cis to become subject to Workman's Compensation laws.of California."` <br /> ........... Owner <br /> Signed ---------- A <br /> -- - -------------- <br /> By .............. :............. ...•------ ................ <br /> ----- . ...... <br /> (if oth Vthl3n owner) <br /> R. DEPARTMENT USE.ONLY!, <br /> APPLICATION ACCEPTED BY .......... ----------------r-................... -------- `DATE�,. <br /> -ISSUED ----- -------- ------------------- .......................DATE -_ --------------------------------- <br /> BUADING71`EI�MIT ........ <br /> .� %. I A ............I------------ <br /> ADDITIONAL COMMENTS%-- ........ -------------- ................. ------­......................................... <br /> i._......_._.._:-------------- '�' 4 /N. <br /> ---------------------------- .................. _illl....... ... ...... ----------- ----- <br /> ........ ------------ ............................................. <br /> ----------------------------------------------- .......... .............................. ............ ------­-------­­............................................................. <br /> ...... ...... <br /> -------------------- ----------- . ...................................... ... .......... ......... ............................ .3;r.......­ ...'- <br /> EH <br /> ......>.. e----Date .......... <br /> ------------ <br /> Finol Inspectionty., ------2��---- <br /> EH 13 24 1-68 Rev. % - . I <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT. 8/7h 3M <br />