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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> .................. ..... s .............. <br /> Permit Na. 75....... <br /> (Complete In TAplicate) <br /> VrAr <br /> Date Issued .. <br /> ............... ........ ................ ........... This Permit Expires I Year From Dot*Issued Z.. ...... <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 /> JOB ADDRESS/LOCATION C.. CENSUS TRACT ........... <br /> Owner's Name ---------------- ........... ........................... .......Phone <br /> Address ............... 0 c <br /> 772-47. <br /> --- -------- 4�........ .......... y ................. <br /> Contractor's Name .......Ca4��e—�IA�--------- ....License # ......".�YZ7j Phone .... <br /> Installation will serve: Residence[]Apaitment House❑ Commercial C]Traller Court 0 <br /> Motel []Other,.-.,--" <br /> ----------- <br /> Number of living units:.. ----. Number of bedrooms ...__Garbage Grinder ............ Lot Size'...AV—....1w.F..................4 <br /> ;e A*701 <br /> J_ ­7 _2 4t -1vote <br /> Water Supply., Public System and name ............. ......... .............................................Pi <br /> Character of soil to a depth.of3 feet: Sand El Silt 0 Pay 0 Peat 0 Sandy Loom 0 Clay Loom <br /> Hardpan C] Adobe 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 TANK; ] Size. .•............................................ <br /> Liquid Depth •----...............:..--. <br /> Capacity ------------­ Type ---------_-__- Material...................... No. Compartments ....................... .r <br /> Distance to nearest: Well -------------------•-•--•---........Foundation'...................­ Pr p.­Un6 .�::................. <br /> 0 <br /> LEACHING LINE No. of Lines ....._._1_____________ Length of each line._..... ............ Total length ......�,IP............. <br /> 'D :Box Yr Type filter Materia!'--.-A&ICkf�' epth Filter Material ............... <br /> ?�' ................. <br /> ............ <br /> Distance to nearest: Well ___/Y011Z .... Foundation Property Line <br /> SEEPAGE PIT Depth­._457!------ 'Diameter Number ..__....__._l_..._. ,:' Rock Filled Yes No 0 <br /> Water Table Depth -------- ............................Rock Size ---------- <br /> Distance to nearest: Well _...... .:_._._....Foundation Prop. Line .... ...... <br /> REPAIVADDITION(Prev. Sanitation Permit# ------------­------------ -- .... Date .......... ................ <br /> SepticTdnk (Specify Requirements(......._._..........._........... ............ ................................................................................. <br /> Disposal Field (Specify Requirements) ------------------- <br /> ------_- --------------------------------------------------- <br /> ------------------------------- <br /> -- ......... <br /> -------------------------------------- ----------------------------------------------------------------------------------------- .......!t---............ ........ ................_.......--.•----- <br /> ----- ------------- <br /> ..................__--------- <br /> --------------------------------­­------------------I.................. ................................................................................. <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 Joaqi In <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Horne owner-or licew.-". <br /> sod agents signature certifies the following: T <br /> .1 certify that in the performance of the work far which this permit is,issued,-i%'holl not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Owner <br /> Signed -- '.!!.=! ..rfU /N�i . <br /> .ByBY <br /> .......... <br /> ............ Title ................ .......... ................................. .......... <br /> ilf-other than owner} <br /> _"R,DEPARTMENT USE ONLY <br /> BUILDING <br /> 6- <br /> APPLICATION ACCEPTED BY - -------- ----------------- OAT <br /> - eav <br /> BUILDING PERMIT ISSUED ..._.1--------­--------- ---- ------- -------------------------------------------------------------DAT ------------- ............ <br /> ADDITIONAL COMMENTS ......................................................... <br /> ---------- -------------------------------------------------------------- ------------------- -------------------------------------------------------------------------------------*...... ............. <br /> ------- ------ - ---------------------- <br /> ------------ ........_:_...-•------..._.._.................._.._----- <br /> ..................................*........*---------- <br /> --------- ------- -------*........ . . ..... ........*..........*............... <br /> - ----------- -------------------I------------------------- -----------;------ ------ ...... ............. <br /> ---------------------------------------- ----------------------- <br /> Final Inspection by: .......................... .............. ........... . --- ------ . . ........... <br /> ---------- ------Date .. ... ��r <br /> EHJ3-2h 1-68 Rev. 5M <br /> SAN OAQ CAL HEALTH DISTRICT 8/7h 3M.. - <br />