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FOR OFFICEUSE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ------------------------------------------ -------------- Permit No. Lf: <br /> (Complete in Triplicate) • <br /> ---------- ---------------------------------------------- Date Issued <br /> This Permit Expires 1 Year From Date Issued <br /> ----------------------------------------------------------- <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 /> -------------------- -----`--------CENSUS <br /> - --- <br /> ��c CT ------ -------------- <br /> JOB ADdLt8/IJ0(.AYJ0Nf'­'�1_ F—------61 !20M'Z$_,j -- ---------CENSUS TRA <br /> ----------F11 i_�_§.H__ER----------- -�-Q--��---'----- --------------------.--;--------------•-------------------Name ----------------------------------Phone ------------------------------------ <br /> Address -------------- ----------------- City ------------------------------- ........ <br /> ------- ---------------------- <br /> License - <br /> Contractor's Name # --------- ------------- Phone <br /> Installation will serve. Residence Apartment House-E] Commercial :L]Trailer Court ',E] <br /> Motel E]Other -------------------------------------------- .... .... <br /> Number of living unitsd 'N tuber of bedrooms -_._-__Garbage Garbage Grinder WO_ Lot Size .-ACRF66 Z---------------- <br /> Water Supply. Public System and' name -------- --------------------------------------------------------- --------------------------Private W�, <br /> . I . <br /> -- <br /> _1�1 . . ke � <br /> haracter of soil to a depth of 3"e-t,., Sand Clay E] Peat Sandy Loam e__-Clay Loan' <br /> Hardpan E] Adobe.,[:] Fill Material. if yes pe ---------------------------- <br /> (Plot7plan, showing size of,. lot, iocd�tion of system in relation to, wells, buildings, etc..,must be placed on reverse side.) <br /> NEW, <br /> INSTALLATION: �(Nci septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> _,Y------�577--------- Liquid Depth --- \j <br /> 'TREATMENT SEPTIC'TAN K <br /> PACKA'dESize---- <br /> Capacity ---- Type8�-FA-11- Matericil---C0_fVC-:___ No. Compartments ------- <br /> 51 1 <br /> istdnce'to'-n'&drest; Well ----FoundatOn ��_: <br /> ---------- Prop. ------ <br /> "D --------------- <br /> L NG LINE No.-i.6f Lines�____ ----- Length ofEACHII each line____40_6,t 4jotal-� Length <br /> - ---Deoth Filtef.-)Materiala, <br /> -D' Box ---------­--------- <br /> . 5�jype,17i,lter Materia -------------- <br /> 't"W' <br /> I Dis aqce /�i a Foundation Property Line ----------- <br /> -- -- -------- ----- I <br /> 7 --- Rock No' <br /> �De Nu Yes <br /> SEEPA2E±j --- Number i <br /> ter e De th oc Si <br /> Distance to nea -- --- --Well --------- -- ------------------F dation --------- Prop. Lin, --- ------- <br /> REPAIR/ADDITION(Prev: Sanitation Permit# ----------------------------;----------------- Date.----_--.-_-----_-----_--_-___-._--1 <br /> Septic <br /> ate----------------------------------- <br /> Septic Tank (Specify R6q6irements) ------------50.1-4--- -- ------ _,bE�Ei P P-5_41_1-- - ------------ <br /> :,j , <br /> Disposal Fibld (Specify' Requirements) ....... _61 <br /> ----------- -- - ----------------- <br /> ------- -S-01-4-------! _Af6-- --------- <br /> —---------- ------------------------- ------------- -------------- <br /> (Draw�xittinj anaWq)6ilr6d�Wdition on reverse side) <br /> I hereby certify that I have;prepared this application and that the work will be clonein accordance with Son Joaquin <br /> - r,-- 0 .1 r licen- <br /> sed <br /> Ordinances,.State;Laws, and Rules-:.arid-Regulations of the Son Joaquin Local Health,District. Home owner o <br /> sed agents signature certifies the following:--- <br /> "I certify tha in pe or ce-, -he work for-which this,.pormit is issued, I shall not employ any person in such manner <br /> as to bye su ect a' _:,a�n_ a ensation laws of California.- <br /> Signed Owner— <br /> ----- - ---- ---- wr-'r <br /> By ----------------------------------------------------------------------------------------- Title ------ -- ------------------ -------------------------------------------- <br /> (If other than-owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED By ---------FIKa-------- ------------------------------------------------------------------- I)A<E BUILDING"-PERMIT-ISSUED'--- ----------- --------------------------------------------- ATE <br /> --- <br /> LCOMMENTS <br /> ----------- <br /> ADDITIONAL COMMENTS --- -------------- --------- ------------------------------1. <br /> ............ -------------------------------------------------------- <br /> ---------------------------------------------------I--------- <br /> --------------------------------------- .. ---- --- -- - -- ------------------------- <br /> --- --------------------- -- <br /> --------- ----------------------------------------- -------------- <br /> . ... - - --- - ------------ --R-- <br /> --------------- ----1-11----- ------ ----------------------- --- - - -------- <br /> . . ............ . - --- ---- -------------------------------- -- ------ <br /> p ------------V -------Date <br /> -t_e-----5--;;; --------- <br /> ----------------------------------- -- -- --- <br /> Final Insp -- - --- ------------------- <br /> ------------------- <br /> - --------------- -- <br /> SAN 'JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6B`Rev. 5M <br />