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SANITATION PERMIT <br /> APPLICATION FOlt <br />............................ ........................ Permit No. ..Z7-/,' <br /> lComplete In Triplicate) ............... <br /> i 41B <br /> .............................................. <br /> Date Issued 2.: .77 <br /> ................................ This Permit Expires I Year From 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 made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION <br /> ........................................................_.CENSUS TRACT .......................... <br /> Owner's Name ... .... Z;0 <br /> ....... ...... ...................................................................................... .........Phone .................................... <br /> Address ..................City <br /> ...................................... ..... <br /> Contractor's Name --- .. 0 V / <br /> ............................................License ... Phone <br /> Installation will serve: Ida {'Apartment House 10 Commercial OTraller Court IJ <br /> Motel 0 Other..... ...................................... <br /> Number of living units:............ Number of bedrooms ..6.....Garbage Grinder ----__-- Lot Size --------------------—...................... <br /> Water Supply: Public System and name ............................................................................................................Private(3 <br /> Character of sail to a depth of 3 feet: Sand 0 Silt❑ Clay [] Peat❑ Sandy Loom JE) Clay Loam 0 <br /> Hardpan [3 Adobe C) Fill Waterial ............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.) f <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK( Size.........__................................. Liquid Depth ........................... <br /> Capacity .................... Type .................... Material...................... No. Compartments ..............._..%ji <br /> Distance to nearest: Well. ....... ............................Foundation ...................... Prop. Line ......................V.1 <br /> LEACHING LINE Na. of Lines ........................ Length of each line............................ Total Length ............................ I <br /> '13, Box _.......... Type Filter Material ...A�.. ..Depth Filter Material ... ............................ <br /> 1 Distance to nearest: Well ..... Foundation ........................ Property Line .......................y <br /> 40 1 <br /> SEEPAGE PIT Depth ..................... Diameter.. ­­....;..z--Nurnber­ .............. .. <br /> .........­. Rock Filled Yes C3 No:.C- <br /> .. <br /> Water Table Depth­ - ... .............................Rock ............................. <br /> —Distance to nearest: Well ........................................Foundation ..................... Prop. Line .................... <br /> REPAIR/ADDITION Orov. Sanitation Permit ............ ...............................Pate .................................. <br /> Septic Tank ISpecify Requiremeritt) ........... .............. <br /> . .. .........*.............1A........�__-1-4............. <br /> Disposal Field IS Ify Requirements) ..... ...... .............. ............. <br /> ......................... .............................................. ......................---•--•--....---._....................-- ..............................................I................... <br /> .............................................................................................................................I..................!........................................................ <br /> (Draw existing and required addition an reverse side) <br /> I hereby-certify that I have prepared this application and that the work will be dome In accordance with Son jo0olulft <br /> County Ordinances, State Laws, and Rules and Regulations of the Son J*aquin Local Health District. Home owner or Ran- <br /> sed agents signature certifies the following: <br /> dol 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 �pmpensatlon laws of California." <br /> .............. <br /> Signed ....`Z< -,.. ............................................. Owner <br /> e:01% <br /> By ........................................................................................................ Yitle .... ........ ......................................................... <br /> (if other than owner) <br /> ..................-----------------------•--•-•-•... <br /> PWRTMENT USE ONLY <br /> APPLICATION ACCEPTED BY;�. <br /> ......... ..................... DATE ....< . . .....—11.—..--?>- <br /> .....�Z <br /> BUILDINGPERMIT ISSUED ........ ................................................................................................DATE .................................. ........ <br /> ADDITIONALCOMMENTS ....__........... ................................................... .................................. ..---............. ...:.......••................... <br /> ...............­......... .................................................... ................................................. ........... ...........I....... .................................. <br /> ............................ ........................ ... . .......................I........................... ................I......I—......................... ............. <br /> ......................... ........... ...... . ........ . ... <br /> I- ------ .. ........ .... ................. ........ <br /> Final Inspection by; ......... ................. ....Date Date <br /> EH' 13 24 1-6a Rev. 5m . SAN JOAQUIN LOCAL HEALTH DISTRICT- 8/7h 3 <br />