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FOR OFFICE USE.. <br /> APPLICATION FOR SANITATION PERMIT Permit IN <br /> ............... .............. . .-•--------••--_........ <br /> (Complete in Triplicate) <br /> Date Issued <br /> This Permit Expires I year From Date Issued <br /> ..........................I <br /> Application is hereby made to the Son Joaquin.Local Health District for a permit to construct and install the work herain <br /> described. This application is made in compliance with County Ordinance N;o/. 49 and e4isting Rules and Regulations-. <br /> "01 <br /> S TRACT --------------- <br /> JOB ADDRESS/LOCATION _CENSU <br /> Owner's Narne&0.7/7W..&/P.... Phone.................................... <br /> ......................... <br /> city <br /> AddAff _71e.............. ---- ----- -------- .. .... .... ...........­...;. .4 <br /> Address _...? lkens6 *1j?7Z"___Y Phone <br /> -- ------------------------ <br /> '0, e ✓ <br /> Contractor's Name <br /> Apartment House 0 Commercial oTroileir Court F1 <br /> Installation will serve: Residencex <br /> rl: Motel F]Other.... ---------- ---------- <br /> F, Number of living units.---/--- Number of bedrooms J?_"..GAcige'Grinder Lot Size <br /> ...................... <br /> k .......Privatek <br /> Water Supply-. Public System and name ................................................................................. <br /> Character of soil to a depth of 3 feet.- Sand E] Silty: Clay [:1 Peat[I Sandy Loam 0 Clay.Loom <br /> Hardpan❑ Adobe 0 Fill Waterial ............ If Yes,type---------------------------- <br /> n <br /> {Plot plan, showing size of lot, location of system in re atio to welis, 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,] .01 1� <br /> A <br /> SEPTIC TANK{ I Sizei----------------------------------------------- Liquid Depth _._.......-_.........,y/ <br /> PACKAGE TREATMENT <br /> A <br /> Material.....................- No. Compartments _----------- <br /> Capacity -----------------.__ Type __.----------------- <br /> ....Foundation ......................Irop-Line ............... <br /> i Distance to nearest; Well -_---------_-------- <br /> Length of ea6i line------ --------------------- Total Lbnqth ----------- ---------- <br /> F11 LEACHING LINE No. of Lines ---------------------- <br /> .............I......Depth Filter Material ..,---------------------------- <br /> 'D' Box ............ Ty'p'-ed .... . . . <br /> 4 <br /> Distance to nearest: Well --_------------------- Foundation ........................ Property ................ <br /> No.'u <br /> SEEPAGE PIT Depth -------------- ...... Diameter ....... ........ Number ............ ................ Rack-Fillw. Yes 0 <br /> F Water Table Depth`. . .. . ..............................RoFk Size -------------•----•--•......•• N. <br /> Distance to nearest: WeiI --_------- - ------ ...................Fo6ndation ----..............._ pro'r <br /> Line <br /> ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........... Date ---•--------- <br /> ............ <br /> ............................ ----------- - <br /> -----------_____1..........x;4. . .........----_------- <br /> Septic Tank (Specify Requirements) -------------------- --- ------ Z <br /> - ------------ <br /> 13isposal Field (Specaif Requirements, '.. . I <br /> --- z0.... <br /> 0497 1 ----------------------- ........ ---------------------------- <br /> -- ------------­-­-- <br /> -----------_-- .................................... <br /> ------------I..........................................­---------------------- <br /> \....... <br /> (Draw existing and required addition on reverie side) <br /> e <br /> hereby certify that I have prepared this application and that the work will be dols , accordance with Son Joaquin <br /> County.ordinances, State Laws, and Rules and Regulations of the Son Joac�uln Local In Health District. Home owner or licen- <br /> sed agents signature certifies the following-.— <br /> 01 certify that Inthe performance of the work for which this <br /> j permit is issued, I shall not employ any person In such mariner <br /> , <br /> as to become subipct to Workman's Compensation laws of C:aIlfomia." <br /> Signed ......... Title apv Owner <br /> - ------------------------- ....... ........... ........ <br /> ------- <br /> of erj'than., <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPT -D B Y 1/ 4 f---_--------------_..... <br /> ........................................ D AT <br /> BUILDING PERMIT ISSUED ------------- -JDATE .. ..........(.7I- <br /> ............. <br /> -- ---- <br /> ADDITIONAL-COMMENTS <br /> OMMENTS ---------------------- ------------­.­------ ---------------------- -; -•------------------------ <br /> ­ <br /> ---------- ------------ ----- <br /> _.._...-•••------••------- ---­1.......... .............................. <br /> ............. <br /> I <br /> Ft' <br /> Final Inspection y.. —. ....... --_1-1--11--.-A---1-P--f-Pt_-_--------------------------------------A-- <br /> --.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-..-..-.-.-.-.-.-.-.-.-.-.-.-.-.._..-.-.-.-.-.-.-.-. <br /> -----.-..--.-- a..t.e..X. . .. . . --.-f--. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. SM <br /> Flo <br />