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.......... ............ -) APPLICATION FOR SANITATION PMIT <br />......... -----------­------ ............ (Complete In Triplicate! <br />.......................................... I .............. This Perm it Expires I Year From Da#e Issued <br />Permit No. ...... <br />Doti lssued./. <br />Application is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work heroin <br />described. This application Is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: <br />JOB ADDRESS/LOCA,,TION . ..... CENSUS TRACT <br />............ <br />'0 <br />Owner's Name <br />.......... .......... ............ ...Phone <br />Address <br />.. ..... city <br />............ --- ------------- <br />Contractor's Name . ... <br />_ _ ..h_.. - - - -..-._.._.License # ....... ............ Phone <br />Installation will serve: Residence 0 Apartment House f3 Commercial C]Troller Court 9, E. <br />Motel er .4�, ..... .. .......... <br />O�, <br />Number of living uni .. <br />L ts:.... --- Number of rooms .: . ....... Garba�e` Grinder .......... Lot Size ...2_c:. .. <br />Water Supply.. Public System and name .................... <br />..................... .. ... ... ......................... .. Private <br />et: Sand1E] Silto Clay 0 Peat <br />Character of soil to a depth of 3fe Hardpan 0 ❑1� �dyy Loom 0 Clay Loom 01 <br />•Adobe -0 Fill M6teriol ............ if yes, type ............... ............ <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 SEPTIC TANKJK A size. <br />... � � -', 6- - - Af .......................... Liquid Depth .... �6_4 ............ <br />Capacity Type Material ... (fV6,1mw;t_ No. Compartments ..... a .......... <br />Distance to nearest. Well0 -0 <br />---------------------------- ."'..Foundation .....;RIO Prop. Line ....... <br />BLEACHING N LINE Na A <br />of Lines /_____.............. Length each line.Total Len.gtXh <br />9f -i�_Idwwr ...... <br />V Box ------ ... Type filter Material Depth Filter Material ....... i ... V. ......................... <br />...... /.0.. <br />Distance to nearest. Well .. <br />............ Foundation ....... /JP ........... Property Line ....... <br />SEEPAGE -PIT &,-Depth ....... Diameter <br />� Number ............. t..--.... Rock Filled Yes No <br />—Witie'r Table Depth -------- .................. Rbck Size ...... e - <br />Distance to nearest: Well ........................... Foundation <br />R . EPAIR/ADDITIONIPrev. Sanitation Permit # ......------------ . . . ....... Prop. Line ......1. 2 ....... <br />....................... Date .................................. <br />Septic Tank (Specify Requirements). . .................... ................................................ <br />Disposal Field (Specify Requirements) . ------------- .................... --------- <br />..................................... <br />----------------------- ---------- -------------------------------------------------------------------------------------------- ............................ ...................... ........................ <br />------------------------ ------------------------ .............. -------------------------- ---------•---•--••--_.... ......_ . ­­ ............... ................. ....................... <br />(Draw existing and required addition on reverse side) <br />I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin <br />County Ordinances, State Laws, and Rules and Regulations 0 the Son 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 far' which this permit is issued, I shall not employ any person in such manner <br />as to beto subject t orkm9 drnr <br />CoTCalifornia."Csation I <br />Signed ..... -a - ---- -----a ----------------------------- ------ flounce <br />...... ..... ------ <br />By ...... -------------------------- title <br />(If other than owner) <br />r%J1S,,PtVARTM9NT USE _9NLY <br />ACCEPTED APPLICATION ACCEPTED BW ------------ I DATE <br />ISSUED <br />----------- ---------- <br />BUILDING PERMIT ISSUED --------------- ----------- 7 <br />------------=------------------------- --------- ---- .......... .-DATf ........ ......... ----------- ...... <br />ADDITIONAL COMMENTS ------------- ;�� <br />------------------ I I ------- I I -------------------------------------------------------------- --------_-------------------- -------------- ..................... ................. -------------- <br />­­­­ ------ -------­------- r ----- <br />------------------------- * ------- - -------------------- * .................. --- <br />Final Inspection b <br />------ --------- --------------- -- ­­ ....... ­­ . ... <br />.... ........ --------------------- ---------------- <br />---------- ­_ ................. <br />Y <br />-------- ----------- -------- --- ----- ........... <br />.............. ........ <br />EH 13 24 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />