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FOR OFFICE USE: <br /> FOR OFFICE USE; SANITATION PERMIT <br /> APPLICATION FOR SA <br /> Permit <br /> ---------------------------- ........ ....... (Complete iiVTrip'licate) <br /> .......................... ........... ------ Date issued. <br /> ------ ...... This Permit Expires 1 Year From Date Issued <br /> ......................... <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is mode in compliance County Ordinance No. 549 and existing Rules and Regulations: 61 <br /> -TRACT..-.n--------------- <br />—-JOB ADDRESS/LOCATION'.'@-, ----- ------CENSUS <br /> Phone.....,-.....-------------------- ----- <br /> Owner's Name .......... ------ ........ <br /> City Nc_rA.Ill ------ <br /> v ........� p--------­.....­ <br /> Adclress...__5;� __FNAC�_k..... ---0_44.E. --------- <br /> )A Pl �,k .-.License #:2-------I _JA Phone.._TF<�� <br /> Contractor's ------ .... ...-Aic <br /> Apartment House E] Commercial E] Trailer Court El <br /> Installation will serve: ResidenceX <br /> Motel E] Other ........ ........... <br /> IF <br /> e_- <br /> Number of living units:--..... ......Number of bedrooms.:Z....Garbage Grinder......-"-----Lot <br /> Siz .: <br /> --------Private <br /> ❑ <br /> Water-Supply: Public System and name.----- ...........­-­­--------- -- - - ------------ ----------------------- ...... <br /> ❑ <br /> Character of soil to a depth of 3 feet: ' Sand E] Silt E] Clay ❑ Peat F1 Sandy Loam ❑ Cloy Loam <br /> HardponNe Adobe E] Fill Material ... ....If yes, type--------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side) <br /> NEW INSTALLATION: (No 'sept,ic tank or seepage 'Pit permitted if public sewer is-available within 200 feet,) <br /> Size --------------Liquid Depth.-1--'- ------ <br /> PACKAGE TREATMENT SEPTIC TANK )M.C�6,tia Compartments_ <br /> C a pd-ci pe........._-__ <br /> .'MatericilCo <br /> .... Prop. Line...... <br /> Distance to nearest: Well"_M;;�,00.. f7T-7---------Foundation.......... . .. <br /> LEACHING LINE No. of Lines ............. ----- - Length of each line,.."y Total Length -0- F ------ <br /> 'D' Box.. ......Type Filter Material--.. ---.Depth Filter Material. ......................... ------ ....... <br /> IF-7.-Property Line..-_--------- ....... <br /> Distance,to nearest: Well__�A 1) 0_r Foundation Foundation. <br /> E PIT De e Rock Filled Yes No <br /> T—iam 'ter.3!;�__t.QdlINumber. ------------------- ------------ <br /> -.Rock <br /> Water Table Depth..-... .......... -------------------- . ...... <br /> ---- <br /> Distance to nearest. Well.----- .. ........_ ---------------Founclation-__....------ ....Prop.. Line ------------ --- <br /> REPAIR/ADDITION (Prev. Sanitation Permit#------------------------------­------ --- - ---------Date;... ------------ -------- ------- ----- I ir <br /> i1.� , I -------­-- ----- ----------------- .......­�---------- <br /> -------------------------------- <br /> Septic Tank (Specify Requirements)........ ....... ------ ------- <br /> Disposal Field (Specify Requirements)...------- ---------- ........ ... ... ....... ----------i.......... ----------------------- ------- ------- <br /> ------------------------- .......... ---•-------------- ......... ....... <br /> ----------------_-------- ------------------------- ...... <br /> ................. ............. <br /> ------- ------------- ------------ ------_................ ---------- -------­--------------I........... <br /> --- - -- --:--(Draw-w_e-xis_t_i­n_g__o n-ci_requi�e&a'ddifion on reverse side)- — <br /> 4 1 County <br /> this application-inid­tgat the work will be done in accordance with San Joaquin ty <br /> I hereby certify that I have prepareda Son Joaquin Loral Health District. Home owner or licensed age n t s <br /> Ordinances, State Laws, and Rules and Regulations of the <br /> 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 <br /> manner as <br /> to become subject to WorkMan's. Compensation laws of California.",,,. <br /> f S�gn d--- Owner, <br /> ---------------- -------------------- -------------- ---------Owners------ <br /> ............ ........ <br /> Title--- <br /> By------- (If other than owner) ill <br /> "R DAPARTM T USE ONLY <br /> DATE <br /> --- -- -------- <br /> ........... ...... ... ... <br /> APPLICATION ACCEPTED. BY------------ Y <br /> ...DA <br /> DIVISION OF LAND NUMBER....._...--_------ ......... - ------ -- ------ --- ---- <br /> ....L-----­-----­ ---- ----­.- <br /> ------- ----- --------------- -- ----------1-_ ----------------- .......­-------- .......... <br /> .......................... <br /> .............I.......! <br /> ADDITIONAL COMMENTS.. ............ <br /> ------------ -----------­­....... ........... --- ----------------------- -.1........... <br /> .......... 1----------------- -----------------------------I-­--------­-------- -------------------------------- ----------- . ... .. <br /> --- -----------------I------------- -------------------- ---- <br /> ----------­_­---------- -------- <br /> ------ --------------DateJ <br /> Final Inspeciion by: ..... .......... MS 21677 REV. 7/76:[ <br /> EH 13 24 SAN JOAQUIN CAL HEALTH DISTRICT <br />