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FOR OFUSE, .ja <br /> !�!-.��75ATION FOR SANITATION PERMIT <br /> This Permit Expires I Year From Date issued Date I s s ued <br /> ------------------------------ (Complete in Triplicate) Permit No.. <br /> --------- --------------- <br /> Application is hereby made to th6 Son Joaquin Local Health District for a permit toconstructand install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing <br /> Rules and Regulations: <br /> JOB ADDRESS/LOCATION <br /> Owner's Name V W,---- N -------CENSUS TRACT <br /> ----------- <br /> Address ---- ----------------------------------- ------ <br /> --- - -- - - --- -------Phone <br /> -- -------- <br /> ----- ------ S------ City <br /> -------------- <br /> Contractor's Name ------------ -----ve,4Z --- ---- ........ <br /> ----------------------- ----------License - --- --- -- one <br /> ---------------- <br /> Installation will serve: Residence 1�3- Portmeni HouseF] Commercial ❑Trailer Court <br /> motel E)Other <br /> Number of living units: i --------- <br /> --- <br /> Number <br /> -- A----- <br /> ----------/ Number'bf�b�eTOOMS,, -__..2,Garbc!9e Grinder <br /> ----- Lot Size <br /> K-/ <br /> ------------ <br /> Character Of soil to a depth of 3 <br /> Water Supply. Public System and i <br /> ........... <br /> Sand ---------Private ❑ <br /> feet: <br /> Silt Clay [;I Peat❑ Sandy Loam C1 fay Loam <br /> Hardpan 0 Adobe U�111 Material <br /> ------ If yes,'�ype ------- -------------------- <br /> --7Ph <br /> (Plot plan, Showing size of lot, I <br /> OcatiOn of system in relation to wells buildings, etc. must be �placed on reverse side.) <br /> r <br /> NEW INSTALLATION'. fNo septic tank or seepage pit pe mitted if�,public sewe'r'is available <br /> PACKAGE TREATMENT SEPTI,C' TANK'r within 200 feet,) <br /> Size---------------------•-- ----------------------- Liquid Depth <br /> Capacity --------/--------- Type ----------IS------- Material -------------- ------- <br /> Distance to n <br /> -----------------------No. Compartments ---- <br /> earest: Well I <br /> LEACHING LINE -------- .......................Foundation A---- <br /> I - --------------i Prop, Line ------------ ...... <br /> No, of Linels/------------ ----------- Length of each line----------------------- � 1.0 IL <br /> 'D' Box ------ ----- Total ength -------------------- <br /> Type Filter Materiol 2 ----------------Depth Filter Material <br /> - Well --------- ...... <br /> Distance to nearest: <br /> -------------- -------- Foundation <br /> SEEPAGE PIT Depth Property Line ------- <br /> ---- ---I----------- Diameter ----- --------- Number -------------- <br /> I ------------- Rod Filled Yes El N ?-I <br /> Water Table Depth ------------------------ 0�0 f <br /> ---------Rock Size <br /> Distance to nearest: Well 1 11. -.011 ----- <br /> -�7-----------------------Foundation <br /> REPAIR/ADDITION i-----)----------- %r 0 Line ------- <br /> ------------i .1,V, <br /> ------ (Prz#vt- Sanitation Permit# ------------------------ A**f/ ------ Date ---------- <br /> Septic Tank {Specify • ---------------- <br /> Requirements) -- --------------------- -- ---- <br /> ------- ------------------ ----------- -------- ------------ -------- <br /> Disposal Field (Spkify Re�ujrenhients) -------- AI - <br /> ---rte--- D-f- �;1 <br /> - ------------------------------------------- <br /> -------------- --------- /I---------------------F--------------------------- -------- -- ----- ------- t4��-------------- --------------N�------------------------ <br /> �(Draw existing a d re 147------------------t 4 <br /> ion on reverse i y- --------- <br /> addit 6-1 --- <br /> A- <br /> s1le) I----------- <br /> I hereby certify that have prepared. this application an that the work will I c I. <br /> one in accordance with Son Joaquin <br /> County Ordinances,#Stiate Laws, and Rules and Regulations of the SaAadquin Local gealth District. Home a <br /> sed agents signature/0 -ertifies the following: wner or licenm 4 <br /> "I certify that in the performance of the work for which this perm. I <br /> it is 155-1 <br /> as to become subject to Workman's' laws <br /> , ��,N shall not employ an <br /> Signed �Compensaflon lawsof California. I y Y person in such manner <br /> ------------ - --------------------- I <br /> By ------------ -------------------- Owner <br /> ----------------------------------- ----- ----- <br /> (If other than er) <br /> ------ Title --- <br /> FOR <br /> ---------------------------------------- <br /> EN T USE ONLY <br /> APPLICATION ACCEPTED <br /> BUILDING PERMIT ISSUE --------------- -------- ------------------------- <br /> -------------------•------ DATE ------ <br /> TS - -- --- --------------------------------- - -----------DATE <br /> %NAL COMMEN----- -------------------------------------------i------------------------------------------ ------------------------- <br /> ----------------------------------------------------------------------------------- <br /> - ---------7-w --q--------------------- --------------------------------------------------------------------------------------------- <br /> 4�---------- -- <br /> --------------------- -------::------ - - - -------------------- ---------------------------------------------------------- ----------------------------- ------------------ <br /> --- ---------- -------- -------- <br /> Final Inspection by: ------ ---------------------------------------------- <br /> ----- - ------- -- ---------flel.......... ----------------------7----- -------&91---- <br /> ------------------ ----------------- <br /> ------------------Date ------ <br /> T - --------- <br /> C <br /> SAN JOA UIR-R) A�HEALTHz;-DISTRICT <br /> E. H.-968'Rev. 5M. <br />