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FOR OFFICE USE: T <br /> APPLICATION FOR SANITATION PERMIT <br /> ............ <br /> Permit No-7��-340/1 <br /> (Complete in Tripil to) .. . .......... <br /> ........................... ---—----- - ------ --- This Permit Expires I Year Fr6ni,Date Issued Date Issued ..... <br /> V , <br /> Application is hereby made to the Son Joaquin Loco] 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 ADDRESS/LOCATION ...CENSUS TRACT ......................... <br /> .......I............. .• ..... ..................................... ""....Phone -71 <br /> Owner's Name 115� <br /> .............. ?Ae...... <br /> Address I city .—.Ci +J................... ............................ <br /> me-------*---.......... ............................................i----- - -........ ....Contractor's Na .... 4 M---+ ..... ........L 1 ce n s e # .... Phone ..... <br /> Installation will serve. --kesidence-K-A-pa rtment House 10 Commercial E)Traller Court 0 <br /> Motel C3 Other ...... ...... ................ <br /> Number of living units:"-- Number of bedrooms Grinder ............ Lot Size )c ta-r <br /> - I .a ---------- ............... ............. <br /> Water Supply. Public System and ----------------------- .................. -----------Private ❑ <br /> Character of soil to a depth of feet: Sand 0 Silt Cly G Peat E] Sandy Loam E] Clay Loam 0 <br /> 4. Hardpan O�, Adobe ill kateriol "----------- If yes,type .................... <br /> —11 — w A--.- - . . ! k k-M <br /> V . 0Isee <br /> r'; .1 �(Plot pian, showing size of 1�t7lola io s�ystJmi in relation to wells, buildings, etc. must be placed on reverse sicle.)�) <br /> NEW INSTALLATION: lNoP�, p-ge-pit5 _pybric sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPT]CJAN K4f J-y ............ ---------------- Liquid Depth .......................... <br /> Ca pa 6 t*'y-a-*- ----- Type .................... Materhil�........ No. Compartments ...................... <br /> Distance to nearlit. Well ..............I ________________Foundation ................ Prop. Line ......-1-......... <br /> LEACHING LINE No. of Lines ".....t..--"-___._ Length of each line ............................ Total Length ............................ <br /> J1 I! i <br /> V Box ------------ +pe Filter Material. ...................Depth Filter Material I........................................ <br /> Distance to nearer-Well .................................. Foundation ........................ Property Line .................... <br /> SEEPAGE PIT, Depth -------------------. Diameter ................ Number ---------------------------- Rock Filled Yes [3 No <br /> • Water Table Depth .............................. ------------Rock Size "".....-----••----•-I-----•••... <br /> Distance to nearest: Well.-•---------•..... ....................Foundation ........ Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ••.-___--"-."............................... Date ..................................I <br /> Septic Tank (Specify Requirements) ........:7.z.0. ........A�.---- <br /> .................. <br /> ---------------------------------- <br /> DisposalField {Specify Requirements) ...........................•----....-- ----------------------------------------------------------------- .................. <br /> ---------------------------- ---------------------------------------------------------------------------------- -------------------------------------------- ............-...... ........ <br /> .......... ................ - ------------------ ---------- ------------------------------••-----.-------------•---•----- -------••---......................--•-------•----........_....:-................ <br /> (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 Ordinancls, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or Ron- <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 manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ......-.- ----- ----- .................. Owner <br /> By .......... Title .................. ............. .......... ...... <br /> n ownerl --------------------------------------- <br /> I Poi-h-e--iha--- ........................... <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------------------------------------..................................... DATE ..... .................... <br /> BUILDINGPERMIT ISSUED ... --------I.....................................................................L..............DATE ............ ........ .......... <br /> ADDITIONALCOMMENTS ............... ........................................................ ............. .................. ........ <br /> I '.--........*......**..........*---------- <br /> ..............................................I....................... ............................ ..... .................... .................­-­.............. ......I......... <br /> ....................... ------- <br /> . ......................... . ....................-.1------I.......................................................................... ......... <br /> I. ..... .. .. ----------- ---------------------------------------------------------------------------------------------- ......I......*.......... <br /> ..................... <br /> FinalInspection la�- .................................................................................Date .......... . .........I.................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> r- Li 13 24 , zn n--- e A—A— 7 1 7 1 1 <br />