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I FOR OFFICE USE, <br /> FOR Offa,Mi <br /> APPLICATION FOR SANITATION PERMIT Permit No/e-2..-f <br /> .......... ........ ....... <br /> (Complete In Triplicate) ;7 <br /> ......................... Date Issued— <br /> ...... This Permit Expires I Year From Date Issued <br /> Application is hereby mode to the Son Joaquin Locol HealthDistrict for a permit to construct and install the work herein described. <br /> V <br /> This apPj'tcqPon is made in complianq§w <br /> !gh County Ord i nonce N existin <br /> No.549 and g Rules and Regulations: <br /> p3 S <br /> 4 <br /> CENSUS TRACT__ ..... . ............. <br /> JOB ADDRESS/LOCATION <br /> .... .... ...... .T_- ....... ......... <br /> ,tea p ._.Phone. <br /> Owner's Norrie......4- ...... <br /> Address., ....... ..... <br /> - <br /> ; , j <br /> Contractor's N e � Y_� License WP .,Phone <br /> Instolialion,willserve: .. <br /> Residence F] Apartment Hovseo. Commercial ''',,Trailer Court <br /> Motel Other....... <br /> Number of living units:.,i,_0_,.Number of bedrooms. -�q.Garbage Grincle-r,.J.".)...w;,size...... <br /> Water Supply: Public System and name ......... ..........................­­........................ ................ .. ....... <br /> Character all soil to a depth of 3 feet: Sand Cloy 0 Peat E_- Sandy Loom:1 Clay Loam <br /> Hardpan C Adobe[,pK- Fill Materia).. If yes,type_.,.............. .... <br /> (plot plan, showing <br /> ing size of lot, location of system in relation to wells,buiidirigs_etc.rnusi be placed on reverse side.) ......... <br /> NEW INSTALLATION-. 1(N;oysept ic tank.or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTICTANK <br /> Capocity._­))_6q_. _Type,p Compartments.. ...... <br /> Prop. Line_..Z,_)1_-------- <br /> Distance to nearest. Welt - Foundatiori_- 1- 1 f - <br /> Length, <br /> LEACHING LINE Na. of.Lf es_--- -:�Length of each line.., <br /> Lines......_.. ,.Z-11 <br /> 'D' Box, , .,/..-Type Filter Matericil.A-_! IrDepth Filter Material-.., La <br /> Distance to nearest:Well.'_ "_....Foundation-._ 0- ...Property Line..,.,, <br /> Rock Filled Yes El No F iW <br /> SEEPAGE PIT Pepth_04!W_:....Diameter ...... 'Number....-... <br /> ----­------------ <br /> .... .....Rock Size <br /> Woterlable . ........ <br /> Distance to nearest; WellFoundation .... Prop. Line_....,a».,»... .. ._ <br /> Well_ , ................ ...... <br /> REPAIR/ADDITION (Prev. Sanitation Permit#............. ........ Dote.. . .... .... .. . ........ ........ <br /> Septic Tank (Speci*,yPeqOirerrents)...z ... ....... <br /> Dis+posal Field (Specify Requirements). ...... <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 Jb"Uln County <br /> Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Horne owner or liconsed agents <br /> signature certifies the following: <br /> 111 certify that in the performance of the work for which this permit is issued, I shall not employ any Person in such Mann.or as <br /> to become Sub' kman's Co pen on I ws of California." <br /> Signed -------,Ownbr <br /> By ........ <br /> (If other than.bwner) <br /> DE MENT li ONLY <br /> ......... <br /> APPLICATION ACCEPTED B;. DATE _ . ..... <br /> __ <br /> DIVISION OF LAND NUMBER'_.._._: ....._... DATE____-, <br /> ADDITIONAL COMMENTS,'_ ...... ...... ....... ....... ........ <br /> ......................... <br /> ............ ............... ....... ... ...... <br /> ....................... <br /> Flinal Inspection <br /> t tH 13 24 SAN JOAQUIN LOCAL HEALTH DISTRICT F&S 2M,7Y76 3* <br />