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FOR OFFICE USE; <br />APPLICATION FOR SANITATION PERMIT <br />(Complete in Triplicate) <br />This Permit Expires I Year From Date Issued <br />FOR OFFICE USE: <br />Application is hereby made to.t6m Son Joaquin Local Health District � 6v o permit to construct and install the workherein described.Th|oapplication| di /i with County O,6hn N 549 and existing Rules6 Regulations <br />Installation will serve: Residenceg Apartment House F-l Commercial 17-1 Trailer Court <br />Number of living units-...._../ .... Number of bedrooms -O... Garbage Grinder ------------ Lot ------- <br />VVote,Supply: Public System and name ........ ___ ........ ........................... ... ....... ............ ................ —...... ................. .......... Private <br />5�` <br />Character ufsoil to n depth of feet Sand []Pec*[] Sandy Lnwn E] Clay Loom E]. . <br />Hardpan A6o6o[� RUhA���rio�.---|fyo�type ----------' ^ <br />(Plot plan, showing size of lot, location of system in relation to we||v' hui|6ing,, etc. must be placed on n"vwse d6e`} <br />NGVV INGT&L1A7|ON: (No septic tank o, seepage pit permitted ifpublic sewer i»available within 200feet') uV <br />PACKAGE TREATMENT (] SEPTIC TANK Size ............. '~----.._-----_- - Liquid Depth ........... ............ <br />' <br />Capacity ..................... Type ................... --- MoxnioL...................... .No. Compartments. ---------------------------------- ` <br />. Distance - to nearest:~.,.. Foundation_ .......... -' -Prop. _Line. ........................... <br />LEACHING LINE ( ] | Length.. <br />SEEPAGE PIT [ ] Dopth-----Diomwter ..... ......... - Number ....... .................... ' Rock Filled Yes E) No <br />WaterTo6|a Depth .................................... ................... Rock Size -------- ... ................ .............. ' <br />Distance to nearest: Well -------'—............ .. Foundation .................. -'P'op. Line ............... -......... <br />.\ <br />REPAIR/ADDITION (Prev. Sanitation P=rmit#.................. ................ ----------- Date ..................... ----] <br />� <br />Sep�cTank ;Spu�fyRequiremnntoL--.------ .-�. <br />Disposal Field �p fy Requirements)_ ' -."��^w'^ ' �^������---'` <br />-------------------------- �����' -------------_-. ---------..... ......... ............ ---' <br />-'---------------'— ..... ...... ..................... -------------- --- -........... ------ -............. ..... ---............. ........... --'(D,o=oxichng and required addition on rwv*m* side) _ <br />| hereby certify that | have prepared this application and that the p'=,k will he done in ucxw,J*nce with Son Joaquin County <br />Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner n, licensed agents <br />signature certifies the fmUwVing: <br />"| ce,dh/ that in the parf*,n**nc* of ,he work for which this permit is issued, | shall not employ any person in such manner as <br />to become suble W rk' laws of California." <br />Signed_ '-�ovne� <br />-TiMw----.--------- <br />B�___�POP DEPA$Th�ENT USE -' [Y <br />(if other than owner) <br />........... <br />ADDITIONALCOMMENTS ....... ... ................... ----------- -------- ..... ............... ................ ............... ---------- ----'-------' <br />... ..... '­_ .........................��������. �................................ �............ ��������������������������� <br />............... ...... -... .......... ......... --...... . .'.......................... -...................... .................... ------ '----------- ...... -....... -....... -....... <br />� <br />--'--'..'-----'— v -----_~ -�* i�-.----- <br />'---. '--' <br />.DoRnn|Inon*�,on6y`.'..----------—e---m--v-- <br />mmm -ANJOAQU|�LOCAiH�ALTHD|3TR[T Soan». vw <br />