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FOR OFFICE USE: .-APPLICATION FOR SANITATION PERM <br />........... ­ .................... ........ (Complete In Triplicate) <br />.............. ....... <br />Doti Issued/. ?R:;7e.. <br />This Permit Expires I Your from Dot* Jssued <br />............... <br />Application is hereby made to the Son Joaquin 1.6col 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 .............CENSUS TRACT .... .......... _ ........ <br />....................... Phone /..j:R. <br />... ........... ....... .................................. Owner's Name ...... ........... _yV__P <br />Q.............................. ....... <br />Address ------ ................... ....... .......... City ... 1-1 . . ... lf..� ........ <br />IF— ------------- * ------- ...... ......... License # ........ Phone —7 -- <br />Contractor's Nome ... 4n 4 <br />Installation will serve: Residence [Apartment House 0 Commeiclat oTrallor Court 0 <br />Motel0 Other... ...........................••---:........ <br />Number of living units. -..-.I ....... Number of bedrooms ... 9 ...Garbage CkIncler ...... ...... . Lot Slze ....... <br />Water Supplyt Public System and name ............ ; .................. ............. j .......... . ...... . ........ .............. . ................. Private <br />Character of soil to a depth of 3 feet- Sand 0 Silt 153Clay Cj Peato Sandy Loam El ClayLoammE,, <br />'Harclpon[:] Adobe Q( Fill Waterial ............ If yes, type ............... ............ <br />10 <br />t <br />(Plot plan, showing size of lot, I0�tion of system In-relotion to wills, buildings, etc. must <br />be placed on reverse side.) <br />sewer is available within 200 feet,) —_ I --blic"'S'' <br />NEW INSTALLATION: (No septic tank or seepage pit permitted - If public . ow <br />PACKAGE TREATMENT SEPTIC TANK I I ............ Liquid Depth -_-_ ........... <br />capacity _'... Typ�l --------- --- Malarial ......... No. Compartments .................. <br />------- � <br />Distance. to nbaresto Well }...Foundation ........... ........... Prop. Une ............... __- r <br />LEACHING LINE No. of,Lines ... .............. Length of each line ............... ............ Total Length ............... <br />Type filter Material ................... Depth filter Material ...................................... . <br />Distance to nearest: Well .... ... -------- w ....... Foundation ........................ Property Line ........................ <br />SEEPAGE PIT Depth ........... Diorrieter ................ Number --------_-- _ .......... .. Rock Filled Yes 0 No C3 <br />'Water Table Depth .......................... ............... _Rock Size ........................... <br />Distance to nearesh Well--------- ......................... founclation . .................... Prop. Line ............ ......... . <br />REPAIR/ADDITION (Prev. Sanitation Permit# --_--------_-------- Date .---........__.........,_--------•) <br />Septic Tank (Specify Requirements) ................:.......:.........................w.........__...................-•---•---•-----........ . <br />Disposal Fi# (Specify R irements) ------ ... <br />_rM I <br />. ................. <br />... . .................. -------- - <br />.................. ............ ....... .................... ... 11 ............ .... . .................................. .......................... ............................. <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 Rulas and Regulations of the Son'Joaquin Local Health, District. Nome owner of licen- <br />sed agents signature certifies the following: ng: <br />"I certify that in the performance of the work for' which this permit is Issued, I shall. not employ any person in such manner <br />n <br />' <br />ans Compeso <br />as to become sub cot to WVorIA I? nlow$ of alifornia. <br />Signed ............. A� ..........ewn" <br />....... .... "'.......^e..... <br />. ......... ........... ....... <br />... ........... <br />......... <br />By ...... (if . other . . . than owner} <br />.... ------ title <br />FOR DEPARTMENT USBONLY <br />APPLICATION ACCEPTED BY ---- ----- _:,__ .......... DATE <br />BUILDING PERMIT ISSUED . .............. ........... ................ ---------- -----------___.---•---•--- ...... DATE <br />ADDITIONAL COMMENTS ----- -----------------_---------- I --------------------------- -------- ...... ------------ <br />4 ............ ­ ............................. <br />................I.....•---........_.. ------ ----------------------------------- I ....... ......... I ............... <br />............ ....... <br />............ ..... .. ...... <br />. .. .. ......... <br />.......... ....... ......... <br />­ - ..--- .............. <br />... ..................................... <br />I ....... ..................... ----- Date--.....%% ... ........... <br />Final Inspection by: .......... ........ - - ---- --- ------ .... .. <br />EH 13 2h 1-68 Re 5AN JOAQ�97LOCAL HEALTH DISTRICT 8/71) 3M <br />.................. <br />.................... <br />