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FOR OFFICE USE: <br /> APPLICATION r-olt SANITATION PERMIT <br /> . ........;........... <br />.......... .. <br /> . <br /> PermitNo. .............. <br /> ;Complete In Triplicate) <br />....................... ............W.................... <br /> te <br />.............•............------.:............_...---•... . This Permit Expires I Year From Date Issued 7 <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 madelin compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/IOCAT �2,p (2 J_ I. . .......................CENSUS TRACT .................. <br /> Owner's Name -------�--Wltz,4-------- <br /> Addressity ......................... ....................... <br /> Contractor's Name .........._7----------- <br /> ......... .......... .... •.................... ........License # ......................... Phone ........... <br /> installation will serve: Residence Apartment House 0 Commercial OTroller Court C] <br /> Motel Other.......... .............................. <br /> Number of livin .... Nui�ber of bedrooms -.Garbqge Grinder Lot Size . . ...... <br /> g units:--../ j�ft -.. <br /> e <br /> Water Supply: Public System and no me .... ....................................._...---•-----. . Iv to <br /> ...... - -_------------_------- Pr <br /> Character of soil to-a depth of-3 feet. Sand SiltC3 Clay [3 Pow 0 sandy Loam 0 • lay m <br /> -Hardpan 0 Adobe t] Fill)"Wal ............ If yes,type.......................... <br /> (Plot Plano 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 f ] SEPTIC TANK f .. Liquid Depth ................ <br /> Capacity A Type Moterial.A���o. Compartments <br /> Distance to nearest: Well ..... ........... ,.Founclation ...../0......__ Prole. Line ... <br /> _ <br /> LEACHING LINE No. of Lines ......Z.......... Length of each line --- Total Length �2—. <br /> 'D' Box ..../.... Type Filter ......A�1 .:Dep p ift M t ........ <br /> Material r M/ <br /> serial erla .... . ............ <br /> Distance to nearest. Well ... ........ Foundation ......................... Prope4olune '..../�PA�)........ <br /> SEEPAGE PIT Depth ----------------_.. Diameter .......... Number ....... ..................... Rock Filled Yes 0 No <br /> Water Table Depth ­----------- ................. ...............Rock Size 7 ...................... <br /> Distance to nearest- Well ..............:.........................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ......................... <br /> Septic Tank (Specify Requirements) ................. ........................ .................. .....................---••-•. ........ -------................... <br /> Disposal Field (Specify Requirements) ......................... ........ ............. ................. ........ .................................................. <br /> - - <br /> ------------------------------ ----------­------:........................................ -------------­--I................... ...... .......... ............................................... <br /> .......r;._------------------:-•---- -------------------­­................. ---_-------------T------------ ------- <br /> ..............I............r..............I <br /> JD�ciw existing and required addition on reverse side! <br /> I hereby certify that J 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 Son Joaquin Local 1140alth',01stdct. Home owner or Ilcen- <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 n r of employ any,per;&" in such manner <br /> as to becqrnefubject Work tn's Com e sation laws of California." <br /> Signed .... <br /> .... ......................... Owner <br /> By ------------ <br /> -------------------------- --------------------------- ---_---------------- Title ----------------- .............. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - --- --- .............. ..................... DATE ..........M-. <br /> ISSUED <br /> BUILDING PERMIT ISSUED -----•--•-•_---• ..............................­----------- ----DATE ....... <br /> - ---------------- . ................. ...... ............ <br /> ADDITIONAL COMMENTS <br /> Q0 <br /> -----------------•-- 11.................. ............................... --------------------------­ .............. ............. ­----------------- --------• <br /> *---------------- ---------------------------------- <br /> ........... .. . . - -3-------------------------------------- <br /> .......... <br /> Final Inspection by: ............•--•--..-_._......----............... 4 ......... ......................Date ..., <br /> EH 13 2L 1-68 Rev. .5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />