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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ..............f:ef.................................... PerLnit No. . ��.71S� <br /> {Complete In Triplicate) .... ';7J <br /> ............ ........��­.................... /-,, -3. <br /> Date issued ... .......... <br /> ................................._----..•----.........---_ This Permit Expires I Year From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit <br /> mit 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 ....-.......I..............................CENSUS TRACT ....... .................. <br /> Owner's Name .............. ........... ........ ..................I................. ....................Phone ..-••-..........-, ......... <br /> Address .................. ........ <br /> .......... .. ................ ...... City ... ---------- ............... ... <br /> ........ Phone <br /> Contractor's Name -------- ...........License <br /> Installatip''n will serve- Residence 0 Apartment House F-1 Commercial oTraller Court C] <br /> Motel ❑E]Other...............•••••-----.__.._............. <br /> r A Ing units:_ Grinder ............ Lot Size ... <br /> Number of liv ...... Number of bedrooms _......Garbage......Garbage ....... <br /> Water Supply: 'Public System and name ---- ........ ......................... ............___................................................Private C3 <br /> Character of sail to a depth of 3 foot. Sand 0 Slit 0 Clay [:] Peat 0 Sandy Loom 0 Cloy Loom � <br /> Hardpan El Adobe 0 Fill M6teriol ............ if Yes,type ............... ............ <br /> Mot plan, -showing size of [at, lo6tion 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 public sewer Is available within 200 feet,} Y) <br /> PACKAGE TREATMENT . SEPTIC TANK f I Size-.44.k.b....)(/0.............. Liquid Depth ... ................ <br /> Capacity 'l.p,.O.O.. Type Moterlol.t&*J_ ---------- Na. Compartments ... .............. <br /> Distance to nearest: Well ... .. ................ Foundation ...................... Prop, Line ... <br /> 'LEACHING LINE No. of Lines.......... Len gth`of each Ii ...... ................ Total Length ... ....I...... ... <br /> V <br /> Box 7,/ ......Depth Filter Mated I <br /> Type Filter Material a .....I....................... <br /> Distance to nearest. Well ........................ Foundation ..................... Property Line ......................... <br /> SEEPAGE PIT Depth Y_AAA/Aiometer ............•___........... Number ................. Filled Yes �[3, <br /> tock ;e <br /> WaterTable Depth ------------------------------------------------I (/Iiz .... ... ......... <br /> i. . 7 Prop. Line ................ <br /> Distance to nearest: Well -.......................................Fou otion --- <br /> 119PAIR/ADDITION(Prev. Sanitation Permit# .............._................... ........ Date ................................... <br /> SepticTank-(Specify Requirements) ------------- ........................ ....... ............................................................................................... <br /> t. <br /> Disposal Field ISpecify Requirei!nents) ...... --------------------------------------------- --------------------------------- ........ ........... <br /> ----------------------------------------- .............. ---------------- ........ .......................... ------- .......... <br /> --------------------------------------------- <br /> . ............... <br /> ----------------------------------------_-.11-------------------------------- ......... -----------­--------__.........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 J"qIn <br /> U <br /> I H <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local ealth,,Disirict. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that In the performan ie`of the work for'which this permit ISL ISSUQd, I shalt. not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ----- --------------- ................... Owner <br /> By ---------------41le-4 7t C�l- — ---- - ------------------------ litle .................................. ........................... <br /> (if other than owner) <br /> TR DEPAkTMEMY WE ONLY <br /> APPLICATION ACCEPTED BY L --- DATE ----- - <br /> BUILDING PERMIT ISSUED --------------- - ----- ---- ---------------- <br /> ADDITIONAL COMMENTS --- <br /> ---------------------*---------*-------------------------------------------------- ---------------------------------------------------------------------------------- ­----------------- .............. <br /> ---------------------------------- ---------- --- -- ----I...... ........... ------%­--------- -•........ .................. .........11_ ...... <br /> ------------------ ..... <br /> -------------- P- ---- ... . . ... <br /> Final Inspection by. ...... . ......... .......___-------­--Date <br /> .... ....... --- ---- - ---- <br /> EH 13 24 1��6:8 SAN JOA IN LOCAL HEALTH DISTRICT '8/7h 3M <br />