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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PE"T <br /> ----------*----------------- <br /> ----------------------------- <br /> (Complete ift-Teiplicate) -Permit Nq,.--7-Z-,,, <br /> ----- ----------- <br /> ----------I------------------ ---------------------- - <br /> -----------------------------------------------—------ This Permit Expires T Year From Date Issued <br /> Date Issued Z <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct!azd install the r rein <br /> Pu <br /> This application is made in compliance with County OrcllnanceiNoO9 and existikg Pu es 94. 0- <br /> JOB ti <br /> ADDRESS/LOCATION . <br /> ------------ ------- <br /> Owne'r-s Name: B4108 ------- <br /> ------ <br /> -------------------- <br /> ----- ----- -------------Phone <br /> t-7 <br /> ---------- <br /> Address ---oq-- <br /> -------------------------------------- <br /> Conteact6r's Name ;.!e---.License 7 <br /> # -12)-T- Phon� eZ-3. Yl$-O <br /> Installati on will serve; :Residence partment House Commercial <br /> _]Trailer Court <br /> Motel 1i Other ------------------------------------------- <br /> Number of living units:---I Pg . --/---- Numb`e'� of bedrooms --2------Garbage Grinder ----4------ Lot Size <br /> A ......... <br /> Wate:r Supply: �ublic Syste"m and name- -----------il-----------------------------I-------------------------------- <br /> I ------------------------------------PrivateV <br /> Char6cter;of soil to a depth of 3 feet: Sand Silt 0 Clay El Peat E] Sandy Loam Clay Loam <br /> Harclpan E] Adobe El Fill Material ------------- If yes,type ___ <br /> ------------------------- <br /> (Plot '-P,16h, sho,ncing size of lot, locati <br /> on of system in relation <br /> to wells, buildings, etc. must be placed on reverse :side.) <br /> NEW JI Lk <br /> TION:. (No septic tank;,61.r seepage pit permitted if public sewer is available within 200 feetJ <br /> PACKAGE',TREATMENT SEPTIC TANK Size------------------------------------------------ Liquid Depth ----5- -;......... <br /> c6pacity Type Material 0- No. Compartments <br /> Distance to nearest., Well -----/4-0---------------------Foundation ----/-P----------- Prop. Line ----37.. ........ <br /> LEACHING LINE No. . of Lines ---;___3_____________ Length of each line------- ------- Total Length --- ------------- <br /> 'D' Box --L4-an- Type Filter Material ...02.--------Depth Filter Material ----- ------- ------------- <br /> Distance'to nearest: Well ------- ----------- Foundation ----- b-__-_______ Property Line ......... <br /> SEEPAGE PIT Depth -------------------- -Diameter ---------------- Number ---------------------------- Rock Filled Yes :E] No 0 <br /> Water Table Depth -------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest. Well ----------------------------------------Foundation .--------------.---- Prop. Line ............. <br /> REPA:JR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ..................—------------- <br /> SepticTank (Specify-Requirements) -------------------------------------------------------------------------------- ----------------------------------------------------------- <br /> DisposalField (Spec:ify.:,Requir,e,me1nts) ----------7------------------------------------------------------------------------------------------------------------------------- <br /> I------------------------------------7------------------------------11---------------------------------------------------------- ------------------------------------------------------------------- <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 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 tobecome subject to Workman's Compensation laws of California." <br /> Signed --- --- I ------------ Owner <br /> I -- -----------------------------------*-------- <br /> ---- ------- ---------- - <br /> By .... - ---- ------------------------------------ Title <br /> (If other than owner) <br /> --- <br /> F DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE ------- <br /> BUILDING PERMIT ISSUED ----------------------------------------------------------------------------------------------------------- <br /> ------- ----DATE ------•-------------------------= <br />