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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERM-IT <br /> ....... .........­---------- pro 6 <br /> ........ (Complete in Triplicate) Permit No. ....... ............ <br /> .......... ........ ............ Date Issued 7�1 <br /> ...... .... ... This Permit Expires I Year From 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 macI16 in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .... V�. ..... ...... ...... .........CENSUS TRACT <br /> ........... <br /> Owner's Nome <br /> ----­-------- ............ A.4 ...... <br /> ...Phone ......... <br /> Address ..... .......City. ........... <br /> ------------ ....... ............. <br /> Contractor's Nome <br /> --------- ---------------------I L i ce n s e Phone <br /> Residence Apartment House[:1 Commercial oTrailer Court 0 <br /> Installation will serve "N <br /> �— f - _3 <br /> Motel E]Other ._.'............................. <br /> Number of living units:.... ... Number of bedrooms _13--......Garbage Grinder ...... Lot Size <br /> i <br /> Water Supply: Public System and name .................__:. .............. <br /> I ----"I-------I——------------Private <br /> r of soil to a depth of 3 feet.- <br /> Character Sand 0 Silt E] Clay El Peat El Sandy Loom Clay Loom ❑ <br /> Hardpan C) Adobe E] Fill Material --------__ If yes, type <br /> ..... ................. <br /> (Plot pfans owing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> _NEW INST41.LA41 O� N: {No septic 'tank or seepage pit permitted if public sewer' is available within 200 feetj <br /> .—­ I <br /> PACKAGE iTREATMENTSEPTIC TANK Siz <br /> e----- <br /> ...... Liquid Depth ....... <br /> Capacity Type :9-S Material.,-.,............ No. Compartments ... <br /> .1 ................. <br /> 1�1. Distance to nearest. Well -----_--------------Foundation 0------------ Prop. line ..................... <br /> . .... ..... .Length of each line... 6_.---.-_-.--.._. Total Length .............. <br /> LEACHING LINE No. of Lines <br /> 'D' Box ---- <br /> Type Filter Material X. /_Depth Filter Material ......... ...... ............ <br /> Distance <br /> to,inearest: Well Foundation Property Line .............. <br /> SEEPAGE P1 T! Depth DiameterP_ZA',X,,' <br /> --- Number .......... Rock Filled Yes [3 No C] <br /> Water T6_61�e Nepth•,_._---"t.........�----------- -_------_---Rock Size ............. ----------------- <br /> Distance to nearest: Well ......... - <br /> --------4-----------1_;-----..-Foundation ....... ._.......... Prop. Line ........ ........... <br /> REPAIR/ADDITION(Prev.'So n itoti o'n",Permit ---------- ........... Date ....•............... <br /> Septic Tank (Sp'ecify Reqt)'irements) N <br /> . .................... ------------------ --------- ------------------------------------------------- ----------- <br /> DisposalField I(Specify-,Requirements) ............ <br /> -------------­­----------- --------- ------r-------------­ <br /> ............. <br /> ................ ... . ... -------------- -------------I------------------------------------- <br /> ............ .................. -------- <br /> ---------------- . .................... ........... ......... .. ..............­_------- <br /> (Drdw 6xisting and required addition on reverse side) <br /> I hereby c9irtliy' that-M7-Wave prepared this application and that the work will he done in accordance with Son Joaquin <br /> County Orclinances, St�ate &w_i—, �Yn—d'Rulles'i bfiid'Regulations of the Son Joaquin Local Health District, Nome owner or licen- <br /> sed <br /> agents Lgriictture certifies.the following: <br /> "I certify tlsat 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 S' ensa_tion laws of California." <br /> kma Co p <br /> Signed <br /> -------------­--- Owner <br /> By .-., ........... ............. ....... <br /> other <br /> ------------------------------- - ------- Title . .. . .... .... <br /> Ithan .......... ......... <br /> f er -owneo <br /> FOR DEPARTMENT USE ONLY <br /> !Y ....... ------- ------ <br /> APPLICATION ACCEPTED ..............7--.-r............. DATE <br /> —ISSUED <br /> BUILDING PERMIT <br /> ........ --------- .......... ....... ... <br /> ADDITIONAL COMMENTS ... <br /> ............. ............... ................ ------------------------ -.C:..........7__­�%........... .................................. <br /> .......... --------------- ..............-1............................... ....... .... ............... All �4 <br /> ..................... <br /> ----------- --------------- ................ .... --------------*...... ------- ........ <br /> --------.. <br /> ------------- --------- ------ <br /> Final Inspection by.. ------- --------- .. ....­­­------_-------------- .................. ............... Date <br /> I .............. <br /> ti <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 13 24 <br /> 1.'68 Rev. 5M <br />