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F R OFFICE -SANITATION PERMIT <br /> F APPLICATION FOR Pe'it <br /> rm <br /> ... ... (Complete in Triplicate) f-,f-7-3 <br /> Date Issued A................ <br /> :.. <br /> This Permit Expires I Year From Date issued <br /> _NL ruct and install the work herein <br /> J-Hbblth District for a permit to const nd Regulotionst <br /> Application is hereby made to the Son ioaqui�__Loco a t ordinance No 549 and existing Rules a <br /> described. This application is mode in compliance with Coun <br /> CT ....... <br /> 1h Count <br /> ........ .....CENSUS TRA <br /> JOB ADDRESS/LOCATION -1-61.___26 ...... <br /> 'PKo—ne...... ............... ......... <br /> ...................7_-........ <br /> Owner's Name ........ ..................... <br /> -- ---- - ......... city <br /> 4 phone <br /> Address ....................... <br /> cense # <br /> ..........Li <br /> Contractor's Name ---------- - .. ......... .......... IaVoTrailer Court 0 <br /> Apartment House 0 Commercial <br /> Installation will serve. <br /> M461 []Other------- ............. <br /> . .......... <br /> Number of living units...J_ _-Nurn_be_�r of b6clrooms­.!�Gdrb6ge Grinder ------------ <br /> Lot Size .. <br /> I 1. . ..... ............ Private 0 <br /> ------------------------------- 1244 <br /> Water Supply; Public System and name ............ ......­­-------------------- . - y Llc�ah-1 ❑ <br /> - <br /> y [] at 0 Sand Clay Loam <br /> CIO <br /> Character of soil to a depth of 3 feet! - -S�nd'O Silt 0 <br /> Adobe' -Fill Material .... type .................... <br /> Hardpan 0 ....... - if yes, <br /> buildings, etc. must be placed on reverse side.) <br /> (Plot plan, showing size of lot, location <br /> of. system in relation to wells, <br /> size <br /> septic tank or seepage pit permitted-if-public sewer-is-available-within-200 feet,) <br /> NEW INSTALLATION: ' J ........ Liquid'Depth ....... .................. <br /> SEPTIC TANK( Size..................... ........... <br /> PACKAGE TREATMENT ................ <br /> Material---------------------- No. Compartme nts. . ....... <br /> Capacity .............. Type --------- ............. <br /> Foundation -_------------- Prop. Line ........ <br /> Dist nce-to-�-neorest.,_�,W-ell------- .... .....;�_7 -%-d rZ, ��-� �%� `length r ......... <br /> a Total" Length ------------------- <br /> .......... <br /> LEACHING LINE No. of Lines -------- --------------- Length of !" <br /> ,:C <br /> aterial ...........................------------ <br /> ......... .........Depth Filter, M <br /> V Box ............ Type Filter Material . 1 1� Y=,Z. V, 7 .-Line ... ...... <br /> on. ._..._..__--:_._..--__-•-Property -----_----- <br /> Foundati - <br /> Distance to nearest: WeYes C3 No <br /> Diameter ................ Number ..........................- Rock Filled <br /> SEEPAGE PIT Depth ------:--------- --- I 1i I --- <br /> ..............Rock Size,.-!. <br /> I � ..,Water Table Depth. ........... <br /> J .. ........................ ........Foundation .,............ .... Prop. Line ---------------------- <br /> W f <br /> - ro <br /> Distance to neare�st�" eV------------*......... ......... <br /> Date <br /> --------- <br /> ..................... ...... <br /> ------------- :------ <br /> REPAIR/ADDITION Permit ADDITION(Prev. Sanitation ------ I . ............... .............. .. <br /> Septic Tank (Specify Requirements) ...-•--------------------------•h........ -------- ..0. ....I...... <br /> ......... <br /> e�........................... <br /> ........... <br /> .......... ....... .............................. <br /> Disposal NO& (Specify Requirements) _�C_j........ <br /> ------------ ...................... --------------­f--- <br /> ................ ............... <br /> ------------------------------------------------- ------ __ ......................................... <br /> ---------------------I--------------**----­------_- (Draw existing and required..addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son JoAuin Local Health District. Home owner or licen <br /> sed agents signature certifies the following: 'for which this permit Is issued, I shall not employ any person In such manner <br /> "I certify that in the performance of the work <br /> as to become subject to Workman's Compensation laws of California." <br /> Owher <br /> Signed ---_------------ ---- <br /> tle .......... -------­---....................................... . <br /> By ----- ...... ... ........... <br /> (if other n',owner) <br /> FOR DEPARTMENT USE ONLY <br /> DATE ................... <br /> Y ... . .... ...... .......................................------ ............ DATE ........... <br /> Signed ----- <br /> y - ----- ---- <br /> ��LICAT ........ ....... ..... ............ <br /> ............ -------------------------------- ..... <br /> BUILDING PERMIT ISSUED --- .....1.4 <br /> AD-DW�kAL COM NTS aAlt-11— ................... ....... <br /> NTS <br /> . .. . .......... . - ---- - ........ ................ <br /> ------------I............... <br /> Z <br /> --o •---R..••----....----... ....... .. <br /> ............ ..... . ..... <br /> Date <br /> - - ------ ------­------ ............................. <br /> ction ........................... <br /> Final I pe( <br /> 0 UIN OCAL-HEALTH ,DISTRICT <br /> 7/72 3 L 14 <br />