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FOR OFFICE USE: <br /> ........................................ APPLICATION FOR SANITATION PERMIT <br /> mpfefe in Triplicate} 71� <br />. ........ 1CO Permit No. le <br /> ............. .................... <br /> .................... ...............m................ This Permit Expires I Year From Date Issued Date Issued .e'Z::iLZS' <br /> Application is hereby made to the Son Joaquin toc6l 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 A01 CENSUS TRACT .......... <br /> Owner's Name ......... <br /> . ............ .. .......... ... ..............................I....... ............................ P ....*............ <br /> ...........-...................... <br /> one Address ....... ..... ... <br /> ......:........License # .................. <br /> .......—, City ...SV ............. <br /> Contractor's Name ------ <br /> ;I- -- --- -------- ...... Phone .44�16:7�.425?7 <br /> Installation will serve: Residence D�Apartment House 0 Commercial OTraller Courit <br /> Motel [I Other ......-........... <br /> Number of living units-_J------ Number of bedrooms-.3------Garbage Grinder ............ Lot Size <br /> Water Supply: Public System and name <br /> ......... .............................. .......................... ........................Private <br /> Character of soil to a depth of 3 feet. Sand 0 Slit 0 Cloy 0 Peat 0 Sandy Loom Cj Clay Loom M <br /> S.- <br /> 'Hardpan Ej Adobe Fill M6terial ............ if yet,type1� <br /> ............I.. ............ <br /> .(Plot plan, showing size of lot, location of system in relation-to wells; buildings, etc. must be placed an reverse side.1 <br /> NEW INSTALLATION: (No septic tank or seepage <br /> pit permitted If public sewer is available within 200 feet'I <br /> PACKAGE-TREATMENT f I"- SEPTIC TANK ' - 4 11 <br /> �< ................. <br /> ......... Liquid Depth ....... <br /> capacityT Compartments <br /> ype <br /> 04tance.to nearest: Well ........... ... ..............Foundation .... A�?... Prop. Line ............... ...... <br /> LEACHING LINE CK No. of Lines —------1-11--- Length��of each line----9F Total Len th .......... <br /> V Box A eo, <br /> .... Type Filter Material Depth Filter Material ... ....... <br /> rz- _ ... <br /> ­�'Distance to nearest. Well Fou dation <br /> E PIT lei .......... Property Line _147 <br /> J4 N­.... <br /> SEEPAG Depth Diameter Number ---------"�4.............• Rock Filled Yes....... ....a <br /> Water Table Depth ..........I-------_-------—.9ock Size _/ <br /> Distance to nearest: Well .... ...Fo,unclation ------*j.47..e_ <br /> Prop. Line ..................... <br /> /ADDITION <br /> REPAIR (Prov. Sanitation Permit ................----------- ---------- Date —............................... <br /> Septic Tank ISpecifV Requirements, _............. <br /> --------------- <br /> ----•-------•---•-------••_-------------- ....... ............................... <br /> Disposal Field (Specify Requirementsl ...................... <br /> I _­..................................I—.............. .......... ......... ............ <br /> ------------ ----------- ---------•--------------------------•- ---••-------...---------•--.. . ...................... ........................ <br /> ----------I------------------------------------------------------------------ ---------------------------_­­............ <br /> '(Draw existing and required addition on reverse side( ........................"................7........ <br /> I -hereby certify that I have prepared this application and that the work will be done In accordance <br /> with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hiall& c <br /> Distri <br /> sed agents signature certifies the following: t. Home owner or licen- <br /> sed <br /> 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 suole p-110 workman's Compensation I f California." <br /> Signed <br /> -T <br /> ....... . -19%viit <br /> .............BY ........................................................I I Title .. - - - -------- ......................... <br /> . . <br /> (if other than owner) . ...... .............. <br /> -7 <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> -- --- ------ ---------- <br /> ------- ----------------------------------- DATEBUILDING PERMIT ISSUED -------------------- <br /> -----:----------------- ---- -DATEADDITIONAL COMMENTS 7....... <br /> .... <br /> ...... <br /> -----------I............ ........I--------------- --------------------------------------------- ---------- ------I.......I—---------------------------I­------------- ............. .......... <br /> --------------------I ---------------------------•- --------- <br /> -----------_-------- <br /> . - _---- ----- ­-­ <br /> Final Ins p e ction by: ----------------------------I........I..........j­-----------I----------­--------- . . ...........................)---------- .................. <br /> :------------------------------------- .......... ------- ..........Date ........��2,6­7 <br /> EH 13 24 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH ----- ....I....­.­---------- ...... <br /> ...................... �_ ,S'TRICT 8/74 3M <br />