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FoRoFFICEUSE. ApPLICATIOWIFOR 'SANITATION PERMIT <br /> Permit No: -7 <br /> --------- ------ ----- - <br /> ----------------- (Complete in Triplicate) <br /> Z'k---------,;-------------- Da V-7 / <br /> Date issued <br /> ------------------ ---------------------7------------ Year From Date Issued ThisPermi.t:Expires <br /> ----- ----- ------ -- <br /> ----------------------- <br /> ----------------i�-- <br /> permit to construct and install the work herein <br /> Application is hereby made to the Son Joaquin Local�Health District for a 9 and existing Rules and Regulations: <br /> described. This application is made in compliance with County ordinance No- 54 5-5- <br /> �12010-7 t� �4. ----CENSUS TRACT <br /> __ <br /> A <br /> JOB ADDRESS/LO( <br /> 'A Phone <br /> 9T 0; -IM 69A----------- -------------------- - <br /> Owner's Name ----- ------- > ------ ------------ -- -- --- <br /> - <br /> 04 5;7-13 1 <br /> t city _Rl- 0:7�---------------- --- ----�,72 <br /> Address t License -------- <br /> Phone <br /> Contractor's Name I-- - ---- Cornmercial .oTraller.Cou rt 0 <br /> Installation will serve- 'Residence Apartment HOusie <br /> ❑Motel E]Othei --------------------------------------------- <br /> LotSize ---------------------------- --------------- <br /> Number of living amts:"--- ----- Number of bedroor:hs 3—----Garbage Grinder <br /> ------I-----Private Ej <br /> ----------------------------------------------------------------------- <br /> I Water Supply- Public System and,name ---i------------------ to SandyLoom ,[] ClayLoamO <br /> feet: SondEl -ClaFil� <br /> ' PeoCharacter of soil to a depth of 3f Hardpan.El �&.dobeaterial ------------ If.yes,type _._-------------------------- <br /> f --------------------------- <br /> buildings, etc. must be placed on reverse sidel <br /> lot' location of sYster� in relation to wells, <br /> (plot plan, showing size Of �; available within 200 feet,) <br /> NEW INSTALLATION: (No septic tank or see age pit permitted if public sewer is <br /> Liquid --------------------------- C <br /> ------------ Liq I <br /> Size------------------------------------ Depth <br /> SEPTIC TAN --------- <br /> PACKAGE TREATMENT nts <br /> I No. Compartments Capacity Typp Mated <br /> Line ---6-------------- <br /> Foundation ---Apt--- Prop. <br /> Well -------- <br /> Foundation <br /> to nearest: ------ --------------- <br /> .I Total Length <br /> e <br /> Lines -------------------- L ngth of each line---------------------------- <br /> LEACHING LINE No. of I Material--------------------- ----------------------- <br /> ------Depth Filter <br /> 'D Box <br /> ------------ Type Filter Material -------------- <br /> I -------------- Property Line. --------------------- <br /> Distance to nearest: Well 1--------------- -------- Foundation ----------- Rock Filled Yes 0 No <br /> Diometer ---- <br /> I Number --------------------------- <br /> SEEA PIT Depth -------------------- .* !j f 1— - — - <br /> -------Rock Size --------------------------------- <br /> Water Table Depth --------- <br /> tF I I :- I-I I Foundation -------------------- Prop. Line -.------------------- <br /> ------ <br /> -------------------- <br /> Distance to nearest-' Wei -1 --------------------- <br /> . 1 11 1 <br /> REPAIR/ADDITION(Prev. Sanitation Permit •---------------------- ---------------------- Date ----------------- ---------------- <br /> ----------------------------I------- -------- ------ ------- -------- --------------------------- <br /> Septic Tank (Specify Requirements) ------------------------------ <br /> T-70--------- ------ <br /> Disposal Field (Specify Requirements) J-�75?1—ftc--F------ ------ <br /> A9 --------- <br /> ----------- <br /> I. <br /> ---------------- -------6-0fi!F0-R-"-------- --------- ---------------may -- ------------ <br /> ------------- <br /> Aj <br /> ------------------- {Draw existing and------------------ required addition on reverse side) <br /> d that the work will be done�in accordance with Son Joaquin <br /> ! hereby certify that I have prepared this application an <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 /> issued, I shall not employ any person in such manner <br /> -I certify that in the performance of the work for.which this permit is,i <br /> nsatlo; laws of California. {as to become subject to Wor an's Compensation /Y <br /> J Owner <br /> Si --------------------------- - -- ---------------------- <br /> igned <br /> Yitle ---------- -------------------------------------------------- ------ --- <br /> ------------ <br /> B, --T- <br /> ----- <br /> (if other than owner) <br /> FOR .DEPARTMENT USE ONLY <br /> ------------ <br /> ----------------- ----4. <br /> APPLICATION ACCEPTED By' -- ---- ...... ------------------------- -------- DATE . .. .. <br /> --------------DATE --•-_'-- <br /> 'r- - ----- -------- <br /> BUILDING PERMIT ISSUED ---- ---------- <br /> AVD IONAL COMMENTS .... -------- 1A <br /> --------- -------- - ....... .... <br /> ---------- --------------------- ------- <br /> ............ ------- <br /> --------------------------------------- <br /> .... . ..... <br /> ------ ..... <br /> . .... -------- Dote --- ------ --- - <br /> Fina <br /> SAN j6AQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. <br />