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F- FOR OFFICE USE:� APPLICATION FOR SANITATION PERMIT <br /> Permit No: ... <br /> .................. ......... -------------------- (Complete in Triplicate) <br /> --------- -- --- ---------- -I......... . <br /> ,4111....................... This Permit Expires I Year From Date Issued Date Issued ----- j <br /> Application is hereby made to the Son Joaquin Local Health District for �Aermit to construct and install the work herein <br /> , 1, <br /> described. This application is made in compliance with County OrdinanceNo. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA:TIQ le4�2 5- Aj A-�----....---•-•------CENSUS TRACT ------5----__*7...iT -------------Phone_---------_ -.......... <br /> VA..................... - --;A......... <br /> Owner's Name -------------B'�".9 --------- <br /> I <br /> Address C............ <br /> Contra ---------------------------------------_.-------license # ....................... Phone ........ ....................... <br /> lnstallafio'r►Will serve: ResidenceKApartment House-El Commercial oTrollar Court (I <br /> MotelF]Other ------------------------------------------ <br /> A,0- 16-E........... <br /> Number of livIng units..--,/------ Number of bedrooms .3..-Garba.ge GrincleryjE5. Lot Size je51Q7VFA- <br /> I.. i Private <br /> Water Supply.Aula.kc SLY#!�Muqnd name ------------------------------- ----------------------- ------------Sandy Loam------------------------------ to Clay-------- <br /> 0 - am <br /> Character of soil to a depth of 3 feet-. Sandi© Silt 0 Clay .0 Peat Ej <br /> H a rdpan%L_-Adobe 0_fill Material If yes,type .................I._...._.__ <br /> buildings, et1c. -Ke—placed-on-reverse side.) <br /> (Plot plan, Awing of lot, location/of system inerelationvawelts, r�uii <br /> I �V k..�1-2�W,114 A%:-1 N <br /> NEW INSTALL�TIIOW- 'k.(No septic tankAor seepage pit permitted if=blic sewer is uJiloble within 200 feet,} <br /> PACKAGE TdATMENT SEIPT1104ANK JS --------- <br /> . .r?( V 51........ Liquid Depth <br /> ze--- --- ----------- <br /> X. <br /> Ca aci Type ?fYA57_MaterlaI64.^XKr� No. Compartments ----- <br /> t,,/ <br /> Ty <br /> \4 <br /> istonce­to-nearest:-Well <br /> lines ------?........... Length of each line------7:!� ............ Total Length <br /> LEACHING Lit IE )< No. of- <br /> fox - ___ - Type Filter MateriaIR,0_C1e,..D.,th Filter Material ......... ........ <br /> Distanc to nearest.. Well <br /> - — t <br /> f3 �.�-Oati <br /> *_und on ....A9...!7t------ Property Line ................ <br /> I <br /> CkTF, 0 C1 <br /> SEEPAGE PIT Depth __,12. .....e�-4 _-N'bmI5djT___7: ....... AlZo�­ Iled .Yes----------......':'Diameter ot C <br /> Rock Size <br /> Water Table Dept -------------------- r...... ... <br /> o . Line <br /> iticetA�crest- Well ---------------------------Foundatio -------------- P <br /> ; ;�y ........... Date ---------------------------------- <br /> REPAIR/ADDITION(Prev.;Sanirtaflon Permit# -------------------------------------------- <br /> Septic Tank (Specify Req L.4rnents) ------------------ ---------------N.= .......................... ........................... ------­-- ........ <br /> Disposal Field (Specify Require en s "__..::......_______.-.•_•-•---••- ------------------------- -=----- <br /> __1 ---------------------- ....................... <br /> - -------------------------------------------- ------ <br /> ----------------------------- <br /> ..........A------ ---- <br /> ......................................... ----------- --------------•----•--••-----------------•-- <br /> . <br /> ------ -------------- ......................... sa�j quin <br /> (Draw eiisting and recj�tied addition on reverse side} <br /> I hereby certify that I have-.prepared this application ancillfat the work ill be done in'agcordance <br /> with`County Ordinances, State Laws, and RZIes and Regulations'af the Son Joaquin local Health.District. Home 6wner-or,licen- <br /> sod-agents signaturegertifies the following:L ? I uit , <br /> "I certify th n Pe 0 of the work for whlchhhls^permit-is issued, I shall not employ any peison in such manner <br /> as to beco u Ct W tin's Compensation laws of Califoriiia. <br /> . <br /> Signed ........................... Owner <br /> By ----------------------------------------------------------------- ........ Title ---.--_-:.-.--••-•------------- ............ <br /> (1f other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> DATE r,2 <br /> ------------------------------------------------------------------------- -11-; <br /> APPLICATION ACCEPTED BY... DA ------------•------,......: <br /> BUILDING-PERMI-T-ISSUED-- ---------------- <br /> ---1�_, — -"-_% __- ..-=........................-•---...-:._..._.........---•------- <br /> ADDITIONAL COMMENTS .� .. .. .. . .............. 'I-;.-- : *;� , N ......... <br /> .................. <br /> ........................ <br /> -- ------------ -------- <br /> - ---------------------------------- . . ...... <br /> ----------------- ------ --------- ---------------------------------------------- <br /> - <br /> ------- <br /> ----------------------------------- . .......... ..... ........ <br /> Date ...._ -...... <br /> Final 1"-1 s ction -- ----- ------ a <br /> .............. <br /> SA 10 LOCAL HEALTH DISTRICT <br /> E.H. 9 1-'b$ Rev, 5M. <br />