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FOR of=FiCsE USS APPLICATION FOR SANITATION PERMIT <br /> „ Permit No. . ...5.�5.y <br /> ......................................................... .µ µ.. (complete M Triplicate) <br /> ... .. . . ~Date-Issued... :3 ...;. <br /> . ... ..... ... <br /> - . ;a _- -This Pertnit Explrss 1 Year-from DsOO Issued <br /> . .kation is herebymade to the San Jodquin Local Health District for a permit to construct and lestali the work Iteretn <br /> described. #h!s application is made In.cornplionce with County Ordinance No. 519 and existing Rules and Regulrrtlonu <br /> o. T l• .l�[ .�.J :.5�..�'— ... .:.Cf�NSUS TRAGI , <br /> JOB ADDRI SSAOCATION .........d. t r`. ..... ��:.f .�...... <br /> I .f. . .1 .1.1.�.J .1 .5., : . . ..,... Phone . '02 <br /> ... <br /> Owner's Name ..... ... . . .............. .... . .. /. ; ::. <br /> P .�:. .. ., :, , .5:.�1- Q .�f ..S' ..,city : .. <br /> Address . : '. . <br /> Contractor's Name ......... :... ..:.. ......... ..........Lloanse #, ...... Phare ................. . <br /> �� merclal raller Court 0 <br /> Instgiidtion will serve:' Residence partment Housefl Com <br /> Motel❑Other....:. ,...;............................ t.� <br /> .....„.G+nrb a Grinder . ..... Lot Size ....L•- ... .,..�::... . <br /> Number of living units: . .... Number of bedrooms , °19 ... <br /> .......:,....: ...:.....:...............,,................. <br /> . Prhrate <br /> WaterSupply: Public System and Hama .. .......................................... . <br /> Past Sandy.Loam.0 Cray Loam O <br /> Character of soil to a depth of 3 feet: Sand d Silt E3 --,"Clay C] D <br /> Hardpan Adobe --Fi11 hll�cs�terlof......,.....If yis,ty ............................ . <br /> . e <br /> verses i�.�. <br /> !Plot pian, showing sire of tot, location of sysiern in relation to wells, buildings, etc. must be placed an re <br /> EIN if publLic sewer is suss{able within 200 feet,] <br /> N <br /> INSTALLATIONS (No septic tank or seepagee pit ,permitted ..L.„E1, , .� <br /> 'PACKAGE TREATMENT .� ] S�PXiC TANK f I SIM.. ......��? :��.lY ':'... Liquid Dep#h ..-.,. <br /> �:c, p <br /> Capacity :� �: .:.. Type L.. :.11`��:..t,t Ms rice!....................... No. Gompadmwft •�..'�'�. ....,. <br /> ' <br /> Distance to nearest: Well ....,l.L . ..�...:...........Foundation . .: :: ....Prop. Ltne ...«'.rp°."..�: <br /> M sin ,��.. ... Fatal' kength ........... , <br /> LEACHING LINE ( ] No. of Lines .....�... Length of -• ���• j ' <br /> ' 'D' Box Type Filter Materiale�Gl.j�1� (spth Fer Material <br /> ilt ,l. ,.: .• :(G• <br /> Distance to nearest; Well .........foundation Property Lina ..... .4.............. <br /> SEEPAGE PIT ( } Depth .................... D{ameter Num6er ... .. ':;': ... .... Rade Filled Yes fl No Q <br /> Water Table Depth ........................................... Rock Siva_.. ... . ................. . <br /> Distance to nearest: Well ....... .. .,foundat{on ......... .......... Prop. Line ............... , <br /> t RSPAIR/ADDITION(Prov. Sanitation Per ... ...: ..... Da#e :.'� . ...... .. <br /> Septic Tank (Specify Requirements) ..........'..-. .... ... ................ <br /> Disposal Field !Specify Req.uirementsl ...---• .......•---.: ..... - .. . ... ........... <br /> ............................. . ......... (Draw existing and required addition on reverse side) <br /> �` { .. . . .....,.. .... <br /> ! hereby certify that 1 have prepared this crpplicatia Viand iha!:itis. work will be�doree -in accordance with San lo"V a <br /> County Ordinances, State laws, and Rules and {regulations of.the Scut Joe uln Lacol�-Health Dlilrid. Hunte owner or. Wqa' <br /> i sed agents signature certifies the following: empq its such nwntteet <br /> "I certify that in the performance of the work for which this iiaerinit Is Issued, I shall net employ any p <br /> as to become subject to War man's Compensation laws of California." <br /> \ <br /> Signed , ------------------ ....... Owner <br /> ....11F�.....t:�>_..: ._... �•-- ,. <br /> ....... title ........................:................................ ...... <br /> By (if oer n othawner! <br /> th �. <br /> FOR DEPARTMENT USE NLX _ <br /> APPLICATION ACCEPTED BY ........ ..;. :mss-.. � . ... . DATE ...,. . <br /> �.._..._... DATE <br /> BUILDING PERMIT ISSUED ............. <br /> ADDITIONAL COMMENTS ..................................................................................................... <br /> :..........................: .............. ............... Data .. I.................. ..... <br /> _ _..._. ... ._. ... <br /> .... _.. .. . <br /> Final Inspection by .............. <br /> EH 13 .24 J.-•68 Rev. 5M SAN JOAQUIN OCAL HEALTH DISTRICT 6�7� 31'1 <br />