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FOR OFFICE LiSE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Perm <br /> -------- ....................... .............. (Complete in TA"licatel it No. <br /> ................... .............. . p <br /> !r! Date Issued <br /> This Permit Expires I Year From Date Issued <br /> ............. ..I—............... ................ <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 /> JOB ADDRESSACICATION ....... ............................CENSUS TRACT ............. .... .... <br /> Owner's Name ........13.1-91epic ........................... ..............-.1-1.....................Phone O. J. -7/3,4,6.. <br /> Address . _...,57 <br /> 4M 4— ..... 1tv .... • ...... ......... <br /> ........... ------- C <br /> Contractor's Name ...... ...License #/7787'97. Phone <br /> Installation will serve: Residence Apartment House C] ammerclal[]Traileir Court C) <br /> Motel 0 Other ...............•.........;.......------ <br /> Number of living Number of bedrooms ..,R.....Garbabe Grinder s Lot Size ./40../% <br /> Water Supply: Public System and name .....---•------------------ ....... <br /> ...................................... ................. ------Private 0 <br /> Character of soil to a depth of 3 feet. Sand 0 Silt El Clay 0 1I Peat.[3 Sandy loam 0 - Clay Loom 0 <br /> Hardpan 0 Adobe ej Fill M6terial ............ If yes,type .......... ............ <br /> (Plot plan, showing size of lot, location of system In relation to yells, buildings, etc. must biiplaced/on reverse slie.f <br /> NEW INSTALLATION: (No septic. tank or seepage pit permitted if Public sewer Is available within 206 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK f Size.._. i.................................. .... Liquid Depth ......................i.. <br /> i <br /> Capacity -------------------- Type -------------------- Material.....--............. No.—Compartefients ......... i.1.... <br /> Distance to nearest. Well ------------------ -^-^ �......_.Faundation <br /> *.............. ..... Oropl.ine ....................... . <br /> line ............. Total Length ....................... <br /> LEACHING LINE f j No. of Lines --------------- ......... Length of 6r line ............. <br /> I <br /> 'D' Box --------- Type Filter Material -. _J........Depth Filter Material ....... ................................. <br /> Distance to nearest: Well ..................... Foundation...... ................... <br /> SEEPAGE PIT Depth --------------------- Diameter ................ Number .............. ............. Rock Filled Yes ❑ No <br /> Water Table Depth .......................... 6__ I <br /> .......... --.....hock Size .........................•-•---- <br /> Distance to nearest: Well .............................. A....... <br /> Poundation --------- ---------- Prop. Line .................. <br /> REPAIR/ADDITION(Prev. Sanitation' Permit# —.......... - _•--•------------------E3--_- Date ..................................I <br /> Septic Tank (Specify Requirements) .... ..................................... ......... <br /> ------------------------- .......................................................... <br /> Disposal Field (Specify Requirements) -------1AISY0,44............�la- V <br /> ---- <br /> ----------- <br /> ..4----------33- X_.2,5.........a2��/_ <br /> ..........i-------------------------­­- ..................... ......................... <br /> -----­--------------- <br /> --------------------------------------------------------------- -------------,----------------------._...... -------------------11.............*...........z.......... <br /> 113raw existing and required addition on reverse side) <br /> I hereby certify that I have preparied this application and that the.,[work will..-be done In accordance,with Son Ji6qu,in <br /> County Ordinances, State Laws, and Rules and Regulations of the Sin Joaquin Local Heal&Distdct. Home owner or llcen- <br /> sed agents signature certifies the following: <br /> "I certify that in the-performance-ofthe work.for which this.permit is <br /> issued, I sholLnot employ any person In such manner. <br /> 050­i�come SL;bJect to Workn�qn's Compensation laws of California."' <br /> Signed ---- -------- --- ---------- <br /> ........... Owner <br /> By ------------------- tie <br /> . . ...... <br /> (if n -----------­---------- . ... ....... ............. - ---------- <br /> FOR DEPARTMENT LISt ONLY <br /> APPLICATION ACCEPTED BY ..............L -7 <br /> -----------I------ ---------------------- DATE 1f:7A------- <br /> BUILDING PERMIT ISSUED ........... It <br /> ......................­................................ ------------------- .-------------DATE ........ --------- <br /> ADDITIONAL COMMENTS ------------ . .................................... <br /> ----------------------------------------------------- <br /> - <br /> ----------­­---------------------------------------- ------- ----- -----------_ --------------------------____............................... <br /> ---------- .. . ...... ..... ............ . <br /> --------- -- <br /> --------- -- -- ---- - ----- -------- -- <br /> ....... ---f--- ------- ----- -------- .. .. ------------------- --------------­....... <br /> __V�l � '4 ------ - - -----------•1----------------------------. ........... <br /> /- --- -- - ---- --- -------------- <br /> ---Final Inspection b--y- ------------ ----------- --------- ------------------ <br /> EH 13 2h 1-66 Rev. 5M <br /> SAN JOAQUI LOCAL HEALTH DISTRICT 8/7h <br /> 0 <br />