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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Completo in Triplicate) <br /> Permit No. .7 <br /> ............. ................................ <br /> te' lasued .c- - <br />.........­­­........................ ...... This Permit Expires I Year from Out*Issued This ......... <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 N,o'. 549 and existing Rules and Regulations: <br /> JOB ADDRESSAOCATIW .*,rZ6...� :7- 7.t- .....CENSUS TRACT ........................... <br /> . . ....... <br /> Owner's Name ....c..... . ... ........ . .. . . .......... ............. ...........Phone ...... <br /> ..... ... ......... <br /> ............. <br /> Address ----- ... ..... <br /> ._..-------f.----•-. ...... . ................:.•,.....License # <br /> Contra . ..... ..�P ane <br /> fristollationwi rve: Residence dApartment House 0 Commercial'OTrailer Court 0 <br /> Motel []Other................................. <br /> Number of livinl units:--L-- Number of bedrooms Grinder ............ Lot Size .................... <br /> Water St blit System and name ............................. <br /> ...... ......... ......................." ........................Privet® <br /> Character of-sail to a depth of 3 feet.. Sand t-] silt 0 Gay 0Peat 0 Sandy'Loam Clay Loom <br /> Hardpan 0 Adobe f5' Fill M6terIJ ............ If yes,type............... ............ <br /> (Plot plan, showing size of lot, locia-tion of system, in rel,6tion, tor"w-ells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION; (No septic tank or seepage pit perm' Ifted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT -f ] SEPTIC TANK Size..- ---:--Y .............................M Liquid Depth ............. ......... <br /> Capacity ­------------• Type ......... Mciterrcii'- ................ No. Compartments .................... <br /> Distance. to nearest. Well ....................................Foundation ...............­.", Prop. Line ..........:.-.........6 <br /> LEACHING LINE ;No. of..Lines .........-............. Length of each line.................... Total Length -­---------­............ <br /> `:..."'Type-flte r Wferificil rn <br /> .......... ...Depth filter Material ....... ..........I.......................... <br /> Distance to nearest: Well ....... Foundation .............. ........ Property Line ............ <br /> SEEPAGE PIT Depth ------------- ...... Diameter ---------------- Number .................M- Rock Filled Yes ❑ ' No C] <br /> Water Table Depth ._.Rock Size ................................. <br /> Distance to nearest- Well --------- ........�L........foundation ................. Prop. Line .......... <br /> OEPAIR/ADDITION(Prev. Sanitation Permit# ...........•...... ......I .............. Date -------•--- .............. <br /> Septic Tank (Specify Requirements). <br /> Disposal Field (Specify Requirements) ....... <br /> ....eelle. ............... .......... ............. ..... <br /> --------------------------- -------- ---------------- ----------------------------•--•-------•-.._•....-----•--- <br /> g <br /> -------------------.................. ............­.­­...................................................... <br /> {Draw existing and required-additloA-on reverse side)- <br /> 1 hereby certify that I have prepared this application and that the work will be done In-acc6rclarici'with,5'an Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local flealth,01strict. Home owner or: licen- <br /> sed <br /> sed agents signature certifies the following: .140-` . ) <br /> "I certify that In the performance of the work4or'Which this permit is Issued, I shall not employ any.person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed --------------­-------- ------------------­ Owner <br /> By ---- -------- ­---------------­-- ------ .................. .................. <br /> (*�a-- ----- ----- <br /> ...... Title <br /> 0'th;rm "Ton owner) <br /> FOR DEPARTMENT USE -ONLY <br /> T— 4� <br /> APPLICATION ACCEPTED BY ....­-------- ------------------------------ 14- 4......... <br /> BUILDING PERMIT ISSUED ----------------------------------•---- <br /> DATE . ................. ................. <br /> ADDITIONAL COMMENTS .-----------------------..------•-•.....--.--- ---------- <br /> - <br /> -------------------------------------­­-----------------------------­­­-------1----------­­----------M---------------------------------------------._--.._......_I._...... <br /> ------------------------------------------------------­­-------- ----------------------------L--------- ......... ............................................. <br /> --------•-•I.................................. -­-------------------------- --------M-M------------------------------------ --- ' <br /> -------- <br /> Final Inspection by: .................... ...................... -•----•--................--•---._.-_.._.. --••--- ----- -- -------- ------bic tie'-------;)4fA------------ <br /> EH -------------- <br /> 13 2h 1-68 Rev. 5M SAN joAQUIN LOCAL HEALTH DIST 8/7h 3M <br />