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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ..................... ........-1............... <br /> ......... <br /> (Complete In TplPermit No. <br /> . ............. <br /> ........... ....................I... . <br /> heo) 19,,.;/4ft4 � �2_/ <br /> ........ ..................... .......................... --Date Issued/........ <br /> This Perfn1t Expiref 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 ......oef.e.711Z <br /> --------- ......... .......WV...............CENSUS TRACT .,9.'2t,14Q......... <br /> Owner's Name .... .........9-0 -1:..........C,.;w 1,C,*?.................... ........................ .....................Phone .........._-------------- ........ <br /> Address ........ ----------2?!�Y,7 <br /> .... city <br /> ........... -- <br /> Contractor's Name ------------ <br /> -- - - ----------•--------------.License # ......... ---_-----_ Phone oeZ <br /> Installation will serve: Residence 0 Apartment House{ Cqrnmercial oTrailer Court 0 <br /> Motel 0 Other <br /> Number of living units:._0---- Number of bedrooms --- C)..-Garbage Grinder Lot Size _lKle ................... <br /> Water Supply: Public System and name .....................................................I..............­­........... ..................Private <br /> Character.of soil to a depth of 3 feet: Sand 0 Silt 0 Clay C] Peat 0 Sandy Loom (J. Clay Loam)< <br /> Hardpan,X 0.11 Adobe 0 Fill Material ............ If yes,type.._.......... ............ <br /> (Plot plan, showing size.. of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT f ] SEPTIC TANK[ lf*48------- ....... Liquid Depth ------�.............. <br /> Capacity ----/AV',,Xrd4 Type 6nd-C--1.... Material--- No. Compartments ----- <br /> . <br /> Distance to nearest: Well ........-af!L'...............Foundation ...7�--------- Prop. Line ..AV ......... <br /> LEACHING LINE No. of Lines ........./......... Length of each ... Total Length -Y°-/ <br /> .............. <br /> V Box .... . ... Type Filter Material A41./Depth Filter Material-..._.../.9............---...--.--......... . <br /> 0 <br /> 4,X IX I 1 re <br /> Distance to neast: Well ....... Foundation .......... Property Line .......'/ .. ..... <br /> Depth ------ ... Diameter Number ........ Rock Filled Yes No (3 <br /> (A V&4P <br /> Water Table Depth ......... ----------- --_----_-_-----------Rock Size .....•-1.1 .............. <br /> Distance to nearest. <br /> - Well ..............................Foundation --- ... Prop. Line ------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............. ...................... Date ------••---_.......•.......------_) <br /> Septic <br /> ---------- ............. ------- <br /> Septic Tank (Specify Requirements) .....---•-•----------------- ................:.............. ........................................................ <br /> Disposal Field (Specify Requirements) ---- .............................. -----------------------------------------------_---_------------------ <br /> ----------- ----------------------------------------------------------------------- .......—..................... .............. ••-----•--•--•------------------------------------------- -------- <br /> 33 <br /> ----------- ---------------------------------------------------------------- -----------------­ .................................I-—........................................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health,District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work for whits, this permit Is issued, I shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------- i � . Owner <br /> By ------------------------------- ----------------------------------------------------------------------- Title ... --------------_- ......... <br /> (If other than ownerl ......... <br /> F DE PA TMENT USE <br /> ONLY <br /> APPLICATION ACCEPTED I <br /> ---- DAT E <br /> BUILDING PERMIT ISSU ...... .. <br /> ED . .... . .......... ....... ....... ... .......... ... ........... . ................ ...... . -- ---_---------- <br /> TE ----- ------- <br /> ADDITIONAL COMMENTS -------------- •---------------------- <br /> ----------------------------- --------g7------ ----------------------- --------------­-------- -----------------------------------------­­..................... <br /> -------------------- ----------- <br /> Final Inspection by: .... ------ -------9.�J--------- ................ ------------------- <br /> ......... ------------- Dot <br /> . .......... .......... <br /> EH 13 2h 1-68 <br /> SAN fOAQUIN LOCAL HEALTH DISTRICT <br />