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FOR OFFICE USE• <br /> : <br /> 0 APPLICATION FOR SANITATION PERMIT <br /> ......I——........I.......I................... Permit No. ..7-5--3 ff <br /> ................... <br /> (Complete In TrIpYcate), <br /> .......................I.................... <br /> ........................................................ A, <br /> his PerinlrExpiras I Year from Date Issued Doti Issued... �:LZ <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 made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> Ti .. <br /> JOB ADDRESSAOCA .. . .. .............. . ... .:.....................................CENSUS TRACT' .......................... <br /> tip <br /> . .... ............ <br /> Owner's Name M —.4-1 ...................... ............... <br /> Address . . ..... 0 e o .... ... ..*............**...............'City .................... ........ .................... <br /> Contractor's :..............License Z9144 .. <br /> t . 3 '4=.... Phone .............................. <br /> . 'se# , . <br /> Installation will serve.. Resi 'onceOR"Apartment House 0 Commercial OTraller Court 0 <br /> Motel E]Other............................................ <br /> Number of living units•.:._. Number of bedrooms a.......Garbage Grinder ...... Lot Size......................................... <br /> Water Supply: Public System and name .............................•-._...................._.... .......... ..............................Private <br /> Character ofsoil toadepth of3feet Sand Silt Clay 0—Peat-0-__Sandy-Locim-a - Clay Loom 0 <br /> Hardpan W Adobe fl Fill M6terfal ......If.yes,type............... ... ....... <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc..must be placed an reverse side.) <br /> NEW INSTALLATIONt (No septic tank or see ge pit permitted If public sewerlls available within 200 feet,) <br /> PACKAGE TREATMENT swri,C TANK I ........... Liquid Depth _4 .................... <br /> Capacity Type Material./t. No. Compartments .Y........ <br /> 7— <br /> Distance to nearest. Well ........... A.A....................Fciundiftlig ..... Prop. Line... .......... <br /> LEACHING LINE No. of Lines ------- Length of,each-1.1ne. .....4.1Z./­........ Total Length ...L_......./.-r.......0 <br /> V Box <br /> Type Filter, <br /> ,Matericil. _Depth Filter Material ......Lf................... <br /> Distance to nearest: Well ....... �.-Fd6n­dation ....f a ........ Property Lim, .-..5:r ........ rn <br /> SEEPAGE PIT Depth Diameter ......ig.3.7 Number ..............2?............ Rock Filled Yes 0 <br /> Z..1, pf <br /> Water Table Depth _Q4.111...................Rock Size A. X ........ <br /> Distance to nearest. Well .1.0_40...tr.........Foundation Prop. Line .... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date .................................. <br /> Septic Tank (Specify Requirements) ...:......................................................................................................-1.......................... <br /> VIC <br /> Disposal Field {Specify Requirements) .................................1...................................................................I.............................. , <br /> ........................................... ..............:­_...._._........__.....•..---•................................................................................................................ <br /> .......................... .......................................I------------ ...................... ........................................ ......................I................................. <br /> (Draw existing and required addition on reverse sidel <br /> I hereby certify that I have prepared this application and that the work will he done In accordance with Son J <br /> Ulm <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Heallik.DIstrict.Home awnw or Ilciw <br /> sed agents signature certifies the tillowing:' - I <br /> "I certify that In the performance of the work for which this permit Is Issued, I shall not employ any person In suds mann" <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ............................... <br /> .......... ... - ------- ----- --------------- Owner <br /> By................. .....................i�:. el.l.� . .... ....... Yitle ........."-,. ................................... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY Z <br /> APPLICATION ACCEPTED fiY.................00. _. '......._.......----.._I..._..........__....._....-........................ DATE ......... <br /> BUILDING' PERMIT' ISSUED ........................... .....................................:........................................DATE ................11...................... <br /> ADDITIONALCOMMENTS ..__.......__.:...•.. ........... ................................I——.....I.........I—— .: <br /> ---------- ------11...................... ........ ....................................... <br /> ............................................. .....................*..........................*...................................... ...... ...... ...........­­­­....... <br /> iin"a-I'1'n'ip"e-'c-i i o--n-bi"y":.................. ................ <br /> EH 13 24 1-68 ilev. 5m <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3N <br /> Q3 <br />