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JAPPLIC4=14 FOR SANITATION PERMIT <br /> .......................... ....... <br /> Permit No. <br /> ............. <br /> .................... lComplete In Triplicate) <br /> .............................k............ ........ This Permit Expires I Year From' '06116 Issued Issued .IQ..... .77 <br /> Application Is hereby made to the Son Joaquin Local Health District for a permitto"construct <br /> v I d and Install the work her"ein <br /> described. This..application is mad n1pniplionce-with my Ordinance No. 549 and existing Rules and Regulatlonst <br /> JOB ADD ESS A) <br /> ........ ................................. .CENSUS.. . TRACT ........... .............. . <br /> Owner's a e ... F. ....................................... ............Phone <br /> .. ... ............. <br /> ......... <br /> ...... ... <br /> Address ...... g, A-9-g"Y d <br /> .................city ... <br /> ........................................Lice <br /> Contracto 's a me ... nse # .e2 .. Phone <br /> -Install serVO3 dente[I Apartment House C] Commercial C]Traller Court C) <br /> Motel E]Other <br /> Numb f iving"units:-------.---- Number of bedrooms _!2,_Garbage Grinder..._..:...__ Lot Size .............. ......... .................... <br /> iI <br /> Water p yz Public System and name ............. ............................................................7...............................Private Q)— <br /> Char a soil to a depth of 3 feet. Sand 0 Silt(J Clay E-) Peat 0 Sandy Loom 0 Clay Lao <br /> m 0 . <br /> Hardpan.E] Adobe 0 Fill Material ...___.If yes,type ............... ........ <br /> (plot n, showing size of lot,4%01on of : stem in <br /> ern relation to wells, buildings, etc. must be placed on reverie side. <br /> slowing sl <br /> NE <br /> sewer is available within 200 feet,! <br /> T <br /> "UE REA E T SEPTIC TANK f Site ............ Liquid Depth........................... <br /> PACK <br /> ------------------ <br /> ca ...... Type Material......... No. Compartments .��............ <br /> Capacity ............ <br /> Distance to nearest: Well' .../40 ---Foundation ...................._ Prop. bne ............... <br /> LEACHING Li ....... Length of each line............................ <br /> Total Length. ........................... <br /> V Box ....... .... Type ter Material ....................Depth filter Material ._..-•...........:...................:......_. <br /> • <br /> Distance to nearest: Well ....................... Foundation ........................ Property Line ..........................I <br /> /2; <br /> i. SEEPI I IT ( I A, <br /> . ......... ame r ................ Number ............................ Rock Filled Yes ❑ No 0 <br /> aba Depth ............. ...................................Rock Size ....................... <br /> ----------------------------------Foundation ...........w.. Prop.. Line .................... <br /> REPAIR ODITION(Prov. Sanitation Permit# ....---------------------_- ............. Date .................................. <br /> Septic r A fSpicify Requirements) .............. ...... <br /> Disposi ol Requirements) .,e'z. <br /> ............ .... ...... <br /> ............... .. ------------------------------------ .............. ...................................... ............................................. ...... <br /> ...... ... ..... ............I ....................... ............................................W...........................!................................. ................. <br /> (Draw existing and required addition on reverse side) <br /> I hereby- :0 ve prepared this application and that the work will be done In accordance with Son Jeaclula- , <br /> County 0,d nonces, State Laws, and Rules and Regulations of the'Son Joaquin Local <br /> Health District. "*n%eownq_SrJ( *n_ <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 employ any person in' such ma"nor <br /> as to become subject to Workman's laws of California.- <br /> Signed - Own r <br /> . ........... ----------------------------------_---- ........ <br /> . ......... <br /> By ............/............. :....................-••......----....--•-----•...... Title ......... ......... ............... ....................... <br /> (if other than owner) <br /> FOR DEPARTMEN% USE ONLY <br /> APPLICATION ACCEPTED BY ... ......... ................ DATE 7 6......... <br /> BUILDING PERMIT ISSUED .................... . .......................... <br /> ... .......... ........ .................... .......DATE .... ................... <br /> ADDITIONAL COMMENTS ................................................. ............................... ........... ...... <br /> ... ............. <br /> .............4....... ---------------­--__........... ..........................I.......... ................... ......-.................111--.1.......... .......... <br /> ...........................•----•----.---.......... ­ <br /> -------------- - .................... . ............................I....... ......... ........... ........................................ <br /> .......... ................. ............. <br /> Final 2e ...... . ........... ............... ........... <br /> EH 13 2h 1-68 aev. 5M <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3H <br />