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FOR OFFICE USE: APPLICATION..FOR SANITATION PERMIT <br /> Permit Na. <br /> (Campiete41n Triplicate) ...... <br /> -7111 <br /> .......... ....... ..... ...... ....... _2> <br /> This Permit Expires I Year From Date Issued Date Issued /��............. <br /> .................. ............... ...... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and'd Install the work herein <br /> described. This application is mode in compliance with County 4rdinance.No. 549 and-existing-.Rules and Regulations- <br /> JOB ADDRESS/LOCATION .......... ....................CENSUS`4RACT ....... .......... <br /> 317P. <br /> 01 <br /> ..................................Phone ............ <br /> Owner's Name ......................................I.... <br /> Address ... ................... .......... city ............ ......... ............ <br /> Contractor's Name -----lee�rep_ .....License #-74.0........... ---_------_ <br /> Installation will serve- Residence 0 Apartment House-0 Commercial oTraller Court 0 <br /> Motel 0 Other�........................ ........... ..... 0or <br /> Number of Wing units...../..... Number of bedrooms .2.......Garbage Grinder Lot Size ................. <br /> Water Supply: Public System and name ......... ......... .Private C] <br /> Character of soil to a depth of ifeet:'-- Sand 0 Silt t] -Clay [3 Peat 0 Sandy Loom C) Clay Loom 0 <br /> Hardpan ❑ Adobe RFill-Material ............ If yet,type ........-1. ........... <br /> 7 <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.l <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE-TREATMENT _-,[_].,...._SEPTIC TANK ............ .......... Liquid Depth .................. <br /> / <br /> Capacity; <br /> Type^104------- Material. .......... No. .Compartments Z............... <br /> Distance Jo nearest: :Well .......... <br /> ell ..... ....•................Foundation .Ap. Prop. Line .............. <br /> LEACHING LINE rO No. of Lines .......... Length of each line...0,67:................ Total Length ................ . <br /> Z <br /> D' Box 1ka.. Type'Filter MateriolAjWi(4(,od`.Depth Filter Material /.. ............. .................... <br /> "-Distance to nearest: Well ..................... Foundation __10W....___"_.... Property Line .N:;f ................. <br /> SEEPAGE PIT Depth ------- Diameter Number ----- ...... ............... Rock Filled* Yesg No,-.. <br /> Table Deptliol��.-_4615or ...----...Rock Size ............. <br /> Water ................ <br /> rt <br /> ....... .............. <br /> Distance;to nearest.• Well . ...............Foundation ..Z0_0.... Prop.'Llne <br /> ... ......... <br /> REPAIR/ADDITION(Prev.-Sanitation Permit 9F.......... ................................. Date ------•----.........------------ •) - <br /> Septic <br /> ............ ........... -------- <br /> SepticTank.(Specify Requirements)........... ----------- ........... ............................ ......__.............. ............................................ <br /> Disposal Field (Specify Requirements) --- 1st ................................................................... <br /> ------------------------_-- -----------------------------------­.­------------ .................... <br /> .............................. <br /> ------------- -------- _---------------------------------------- ------------------- --­---------- ...... ------ ------ <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,olstdcf. Home owner or llc*n- <br /> sed agents signature certifies the following: <br /> "'I certify that in the performance of the work for which this permit is issued, I sh,91l. not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ------------------------- -- -- ------- - Owner <br /> ------- ........ <br /> ......... ---------- Title <br /> .......... <br /> .......... .. .................. <br /> BY --- ------------------ -- <br /> (if ot?hon owner) VR DEYARTMENT E ONLY <br /> .......... ........ DATE <br /> APPLICATION ACCEPTED BY <br /> BUILDING PERMIT ISSUED ..... .. .......... ------------- -------------------------------------------- .....................DATE . ..... ----------------- ...7_ <br /> --- - ---------------- --- --------- <br /> -111`�- --------------------- - <br /> ADDITIONALCOMMENTS ----------------------------- -------------------------------------- . ............................. .............. ------------------------- ......... <br /> .... .... ............. ...­------­------------------ ....... -------­...... <br /> -------------- -­­........ --------------------------------- ..... .... ........... <br /> .............. ........... ........ <br /> ...................... ................... .. -- ---- ­ -------------------------------- <br /> --- .................. ......... ......­ <br /> ---------------------------------- ........I----------- <br /> ........... ---------------------- /.-0 7­9-- �7 64 <br /> .......... --------- ------­­­......._-------_­­.11-------------- <br /> Final Inspection by IV- --- ----- ---------------- ------------------ ......Date ........... ...... <br /> EH 13 2h 1-68 1kv. 5M SAN JOAO IN LOCAL HEALTH DISTRICT 8/7h 3 <br /> a3 <br />