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F; <br /> OFFICE USE: .AP_ . <br /> p1ICATION FOR SANITATION'..PERMIT <br /> (Complete In Triplicate) <br /> r.....A................. <br /> ' „-."'-�........... This Permit Expires 1 Year From Date Issued Dote Issued <br /> Application is hereby made to the Son Jooquin local Health District for a permit to construct and install the work herein i <br /> described. This application is made in compliance with County Ordinance No. 549;and existing Rules and Regulations: <br /> JOB ADDRESSAOCATION .-_ ��Jr..- --.-•- '�f�- f.11 1�N !�xvJA............................CENSUS TRACT <br /> Owner'sName .......,�r.......... .� .� ...........................•..--- ... --------- . ----....Phone <br /> Address .................a-ol !J--...--5. ti�`r. <br /> lam.__ .._:..:A-Pe._:......... City ..�/L��.._.._..._..._... <br /> Contractor's Name ..4-1.4s-.-4liL1_LSk--.... •------- ......License #o . .-J` -.J ._- Phone. oZi-7019- '1��.. <br /> Installation will serve: Residence W Apartment House� ..mmercial ❑Trailer Court ❑ <br /> Motel ❑ Other ----------------------- -------------------- <br /> }s i <br /> Number of living units:..../----- Number of bedrooms . 3__.:Gorboge Grinder .........-.. Lot Size ............................................ <br /> Water_Supply-: Public System-and name ..........:....... . ecivate, <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy loam ❑ Clay Loam ❑ <br /> Hardpan ❑ Adobe bd Fill Material ---- ....... If yes,type ............................ ; <br /> (Plot plan, showing size of lot, location of systema in relation-to wells, buildings, etc. must be placed on reverse side.) <br /> u <br /> NEW INSTALLATION: (No septic tahk or see ge pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC! TANK, Size...#T Y..S�............... Liquid Depth ..i /.._..__....._.... <br /> Capacity .J ..---- TYPe pRcAS � Material No. Compartments .... .............1 c� <br /> I e I 'i V, <br /> istan a to nearest: Wel[ ..fly........... ........... ...Foundation/..��------.-.------- Prop. tine as...... <br /> LEACHING LINE No. of Lines.. ---- Length of each line....l�O----....... ...... Total Length .. __.__..._._. .... <br /> 11 <br /> .D' Box - <br /> . Type Filter Material /c�,x Depth Filter Materia! �_. _�� ' <br /> l f <br /> ( � <br /> Distance to nearest: Well /� .............. Foundation rS-.--- Property line 45-0-._..... � <br /> SEEPAGE PIT Depth .......... Diameter Number,*............................. Rock Filled Yes 0 No <br /> Water Table.Depth ................................... ......--;-.-Rock Size ........-----.....-- ------------ <br /> Ir r <br /> Distance to nearest: Well --------------------••-- --•---•--- --Foundcftion _- «....-...... Prop. Line ..................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........................._------ ------- Date <br /> Septic Tank [Specify Requirements)#..........----------- - ----- --•----------------:----•-=--------- ------- ----------- ........... _.. --...---•---._...----..._--•---- <br /> Disposal Field (Specify Requirements) .............................................. _ ..-- ---.. ... ... . .. .................. <br /> ..... ......._ . .�....� <br /> - ---------------- ------- s <br /> (Draw existing and,requared additio0,on_reverse,sidey <br /> hereby certify that I have pr pared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State laws, and Rules and Regulations of theuan,, *aquin Local Heailrhfbistrict�Horne owner or liven= f <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 emplo' any person in such manner <br /> - - �YY .4. <br /> as to become subje to kma Compensation laws of Californ,a <br /> ■ <br /> Signed .:... .i `.. <br /> Owner <br /> .............. . ............ Title ...... .. ......................... ......................... <br /> [If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By .._..--- --I._. `�-�-.......:.................................. . .........__... ....... -• ...._. DATE ...... `x__947. ...:.:..' <br /> BUILDING PERMIT ISSUED _......:........? .,.._..: :.... DATE ...._._...................�....... <br /> ADDITIONALCOMMENTS .... __. ....'........ .................. ....... . --------- ........... --------... -............... <br /> ... <br /> �., _= �.� <br /> .- •------- ------ - --- -- --_... <br /> -------------------- --- -- - .--- ---- <br /> . <br /> Fina! Inspection by: Dote).._...... <br /> .. .__�."�.....--- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT / <br /> F w 13 24 1_,Au u.- rAA 71723 ,14 � <br />