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APPLICATION FOR SANITATION PERMIT <br /> .............. ................................... 2- <br /> (Complete In Trtpflcct6) Permit No. . <br />..... ............. ................................ <br /> Date Issued ..l°........ <br /> .71 <br /> ........ .............................................. This Permit Expires I Year From-Date Issued <br /> reliy made to the Son Joaquin Local Health District for -a permit to construct and Install the work herein <br /> descrxThlApp on Is mode In compliance with County Ordinance No. 549 and existing Rules and Regulationst <br /> in, <br /> ON <br /> ....................................... . ............ CENSUS TRACT..................... <br /> Owner's N a r n a It ...............................................:7.. ...... onpo. <br /> .............. .............. <br /> ........................ <br /> Address ... citi--Z....... ..... . <br /> V <br /> Contractor's Name...... ...... . ..............---=-----.--.License 0 7. Phone <br /> Installation will serves" Residence 0 Apartment House C3 Cornimercial bTraller Court o <br /> ti <br /> Motel Other--------------------.......... <br /> Number of living units; ... <br /> Number of bedrooms -3--Garbage Grinder ............. Lot Size <br /> Water Supply. Public System and name ..... ------_w........ :-_--_---- <br /> 7 <br /> Character of soil to a depth of.3 feats SandX Silt E3, Clay 0 Peat 0 'Sandy Loom 0 Clay Loam' E3 <br /> Hardpan,E] Adobe E3 F111 M6tarlol............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) <br /> NEW INSTALLATION:, (No septic tank or seepage pit permitted If jpubllc sewer is available within 200 feet.) <br /> ....... Liquid Depth ._..:::3._-------_...-. <br /> PACKAGE TREATMENT SEPTIC TANK Size: <br /> 7- <br /> j <br /> J;L <br /> capacity ...... TypA-,-.1­`.`--_­. Material__Lza.. No. Compartments --- <br /> "W_ <br /> Distance to 1% <br /> nearest: Welf* ------- __.-Foundation 7 ......... Prop. Una <br /> .... Total <br /> LEACHING LINE V4-0'wNa 41.1nesq each fine fes. Lanoth <br /> Length'of <br /> -YV1 <br /> W Type Filter Material <br /> ..................loipt`h Filter Material <br /> 3y. - -Distance to nearest: Wall _46 ............. Foundation ............ Property Line <br /> SEEPAGE PIT- I I Depth ---------------- ---- Diameter ................ Number ................... .......... Rock Filled Yet [3 No 0 <br /> T "­.�---Rock Size <br /> Water Table Depth -------------- <br /> --Foun Prop,Distance to nearest, Well d4 , U4. <br /> f=oundation <br /> v <br /> . <br /> REPAIVADI)IT10ii(Pray--,li;n-i;"o'l'io'-n"�P�e`n'rnit <br /> Septic Tank (Specify Riquirements) ............................................................ ------------------- <br /> 7" <br /> Disposal Fiala (Specify. Requirements) ......... <br /> ------------­---------------------------------------------—-----------------------­ <br /> ................ ..................................................................................................................................... ..........-—-------- <br /> .................................•--. ...._........... .....................................................------------------------------•----..Y_...-----.._....------------•-----• <br /> IDrow existing and required addition an reverse side) <br /> I hereby certify that I ho've"prepared this application and that the work will be done ini accordance whir Sea Joaquin <br /> County Ordinances,'.State laws, and Rules and Regulations of the Son Joaquin Local Health District.Home owner Of IIL*n- <br /> sed agents signaiture certifiesthe following: <br /> "I certify that In the performance of the warik for which this permit is issued, I shall not employ any person In-such manner <br /> as to be -bi ct to Wlerk-inan'k-ampensailon laws of California. <br /> Signed .......... <br /> `7 ------ ----------- Owner <br /> .............................. <br /> By ........ .............. ................. .................. ............ ............. .......... <br /> (if other than owned <br /> FOR DEPARTMENT USE ONLY <br /> ..-X ...............146 . <br /> APPLICATION ACCEPTED .......................... N. .... DATE ... <br /> .......................................... . <br /> BUILDING PERMIT ISSUED................................................................................ .......................DATE ......................................... <br /> ADDITIONALCOMMENTS...................................................----------------------------- ............ ................­­------------ .......... ............... <br /> . ...................................................................................................................... ............................................................................ <br /> ............. ........................................... --------------------------------------------------------•----=--------------------- . <br /> ..........I............... <br /> t. .......................................­*..................... <br /> . <br /> - .-..........................­­------------------------------------------------------ - . ................ ­........ .. . ........... .. _­....... <br /> nal inspection by by -: Date .. .................................................... <br /> E <br /> 1 13 2h 1-.§fi Rev. 5H SAN JOAQUIN LOCA) HEALTH DISTRICT 8/7h 3M <br /> ThIs IS 4% C40ty 0-f 44%e awa%er-r to * formoV <br /> CLe <br /> eA0010711 PC 61 7-t-fl, <br />