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FOR,OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ----------­­........................... S <br /> ? (Complete In Triplicate) Permit No. ..................... <br /> ............................•---.......--_....P........... . <br /> ....................•.......... .............. This Permit Expires I Year Fr*m Onto Issu d Date Issued <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 mocI6 in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ATION 3'L 117� :5. 0 ��- <br /> JOB ADDRESS/LOCAT -------1/ -19 ;5 6C.-F _.. <br /> ....... ..... . .............. _.._...........CENSUS TRACT ......... <br /> --e,.--.. ..... .a_V_10.15,�. .......Phone ................................ <br /> Owner's Name <br /> Address - .. ........ .... -------- ....... y 1_41:?. <br /> .................... Cit . ......I--....... ............ <br /> ........... <br /> Contractor's Name --- <br /> I ..License #07,7 0 .... Phone 74 ' <br /> � <br /> ............... <br /> Installation will serve: Residence El Apartment House 0 Commercial'OTral Ier Obwt <br /> Motel0 Other.......... ................................. <br /> Number of living units:- Nuirnber of bedrooms .': '....Garbage Grinder <br /> Water Supply. Public System and <br /> name ...................................._•------------•---..._... <br /> Character of soil to a depth of 3 fed.t. Sand E3 Silt 0 Clay 0 Peat 0 Sandy Loom:C3 Clay Loom <br /> Hardpan [] ,.Adobe FilIM6terial ............ if .......... ............ <br /> j, <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc.- <br /> $;usuke <br /> ' -piaco-4-0 n side.) <br /> ;��, _ -reverse i. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feetj <br /> PACKAGE TREATMENT SEPTIC TANK Size--' ..........•­.. Liquid 'Depth .......... <br /> Capacity/.;Mkp, Material rt <br /> No. Compaments -1............. <br /> Distance.to j`.nearest: Wet 7 1` <br /> 14*' _;111..... ............. oundation .Ze. !�. ......... Prop, Line .^....... <br /> LEACHING LINE, No. ofr!ffes 7!!��Length of each line... Total Length <br /> 'D, ksoxy.4-O.; Type Filter Aaterial A6�. 001)epth Filter Material ....................... <br /> Distance to:nearest: Well Foundation ------- Property Line . . ............ <br /> SEEPAGE Pit -Depth Diameter .............. Number ............................ Rock Filled 5 [3 N <br /> A - -----_---------- ,,Yes oo <br /> 0 1W, tT "S i <br /> "_�ter able' Depth ---------------3-----------....?_....- - <br /> '. %% Roick�Size ............. ............;...... <br /> _j A I <br /> istdnce to nearest:,Well ...........).................... ......Foundation ................... Prop. Line ................. <br /> REPAIR/ADDITION(Prev. Sanitation Permit .......--I/--------- ........ --- Date .................................. <br /> Septic Tank (Specify Requirements) ------ <br /> -------------- ---------------------------------------------- <br /> -­--------- ...............I------------- <br /> Disposal Field (Specify RequTre-m-'Wisiz, ........1-11----------- ................. ...........------------- ------------- --------- <br /> i- -----------------I .................... ---­-----------------­- ----------I......................................I........................ <br /> -------------------------------------- <br /> --------------------------------------------------------------------------------­---...,..................•--...._._..-......._..._._... ........................... <br /> (Draw existing and required addition' on reverse sfde)� <br /> 116 Son Joaquin <br /> I hereby lrtify that I have prepared this application and thtit"the' 'work will be done in accom, ance with Son <br /> County Ordinances, State' Laws, .and Rules and Regulatia'nt.of the3an'Joaquin Local Hoalth,D11sidd.Home owner or )icen- <br /> sed agents signature cert.iroei the following- <br /> "I certify that in the.pe.Oormohcv-6f-the work for which this permit is Issued, I shall 6cit employ any persoin In such manner <br /> as to become sub je6 fci"Workman's Compensation laws of California." <br /> Signed ......................... ----------------------­ Owner <br /> By ..... . -------------- <br /> -------------­----- ---- -Title <br /> - <br /> --- <br /> ----------- <br /> (if of an owner) <br /> FOR 'DEPARTMENT USE ONLY <br /> IV - I <br /> APPLICATION ACCEPTED BY ---- --------------------------:--:-----------------------------------------­-- ---------- DATE 7 ----------- .......... <br /> BUILDINGPERMIT ISSUED --------------------------------•----•--•-•--••-•-------------------------------__......DATE -----------•---------............------- <br /> ADDIT40NAL COMMENTS ........... <br /> .................... -------------------- ------- ............................... <br /> ------------------ ................I------- -- -- ---------------- -- ------- <br /> .............. -------_----_--------------I...................... ----------- <br /> ............. -------- .. ....... ........ ----------- ... ...... .............­'­......................_........ ......._...... <br /> .Olt, <br /> ----:1! ..... - - __ :...............Date . ........... <br /> ..........I——.... ... ..... ........ . .. ..... .. ..... <br /> final Inspection . .. ....I....... �. ............ <br /> .. ........................ .... ................ ...................... <br /> EH 13 2h 1-68 Rev. 5M <br /> SAN JOAQUIN LCiCAL HEALTH 'DISTRIU- 8/7h 3M <br />