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FOR OFFICE USE: APPLIC <br /> ATIONr-ollz SANITATION PERMIT <br /> Permit No <br /> - <br /> (Complete in Triplicate) <br /> 'Date Issued <br /> ------------------------- ------- -------7----- Thisermit Expires I Year From Date Issued <br /> - <br /> Appliaition'i's hereby-nnoJ6fib, the Sarf Joaquin-Local Health District-for-a permit--to,construct and install the work herein <br /> described. This application,,-"' ' n compliance with County Ordinance No. 549 and existing Rules-and Regulations. <br /> VN. 1�7 -------------------------- <br /> JOB ADDRESS/LOCATIOn --------------------------00- ---------------------------- <br /> CENSUS TRACT <br /> Owner's Name ----------------- /,,.2�&------- ....... .... Phone -------------------- <br /> '1777. <br /> ---------------------------------------- <br /> Address --------------------- ---e- -V- ------------------------------------ city ------ <br /> Contractor's Name ------------ AG-Y646 ..... <br /> ->� ------License # ----- Phone <br /> ---------- ----- -------------------- <br /> �F <br /> Installation Will serve: Residence tkApartmek6et-House-[_ Commercial _]Trailer Cour <br /> Motel M Other -------------------------------------------- <br /> Number of living units:---'/----.- Number of bedrooms ---ly------Garbage Grinder ------------ Lot Size ---------------- <br /> Water Supply: Public System and name ---------------- --------------------------------Private <br /> ❑ <br /> ChI ----------------------------------------------- <br /> aracter of soil to a depth of 3 feet. Sand'E] Silt E] Clay E] Peat El San c(y Loam -F] Clay Loam <br /> Hardpan ED Adobe'P9 Fill Material ------------ If yes, type ---------------- ----------- <br /> 1 V <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 seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ I SEPTIC-TANK Size-----4-----_?S•-_-1--------------- quid Depth -57Y...... <br /> Capacity ZY00------ No. Compartments -------1............. <br /> p Type Material- r le 61�% <br /> Distance to nearest; Well ----------------------------------- Foundation ---/0------------ Prop. Line -S----------------- <br /> LEACHING LINE No. of Lines -------7-------------- Length of each line-----kJ�........... Total Length --- <br /> 'D' Box ----E�Type Filter Material ---tzlotk-_--Depth Filter Material -__-_f 8_----------------------- <br /> k 4 Property.—Distance-to.nearest: Well------------------------- Foundation ._____C- - -------- -- Proper Line ----- <br /> - -- - --------------- <br /> SEEPAGE PIT Depth ---- ----- Diameter 5�(....... Num' ber ---- --2e---------------- Rock Filled Yes No C] <br /> Water Table Depth ------------------------ Rock Size 1'f�----------------------- <br /> ------------------------ r <br /> Distance to nearest: Well ---------------- .....Foundation - 1-10----------- Prop. Lin. ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----- ---- ---------- <br /> - <br /> --- -------------- Date _-_----_----_-----__"I-----__-_--) <br /> -- --- <br /> Septic Tank {Specify RequiremenH) -- <br /> ----------------------------------------------------------------------------------- ------------------------­----I--------------------------- <br /> Disposal Field (Specify Requirements) ----------------------------- --------------- ----------------------------------------------------------------- <br /> -------------------------- ----------------------------------------------------------------------=------------------------------------ ------------------------------- <br /> ------------------ ----------------- <br /> -------------------------- --------------------- ----------------------------------------------------------------- --------------------------------------------------------------------------------------- <br /> -(Draw existing and--required-odditicin 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 Rules and Regulations of the San 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 ............ --------------- - ---------- Owner <br /> ----------- <br /> ---- Title <br /> -------------- <br /> By --------- <br /> OFOR-DiPARTMENV USE ONLY <br /> (If oth an owner) <br /> A <br /> -7 <br /> APPLICATION ACCEPTED BY -----/71/---------- - ------------------------------------------------------ -------- DATE ------ J----------- <br /> BUILDING PERMIT ISSUED ----------------------------------------------------------------- ------------------------!--------------DATE ------------------------------------------- <br /> ADDITIONALCOMMENTS ---------- -- ----------- ------------------------------------------------------------------------ ---------------- ---------------=--------•-•---------------- <br /> ------------------- ----------------------------------­­------------------------------ ---------------------------------------------------------------------------------------------------------------- <br /> ------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- <br /> -------------------------------- ---- ----------------- <br /> ----------------------------------------Date I I <br /> Final Inspection by. .0 1--- --------------------- <br /> ------------------------------------ <br /> SAN­JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />