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fOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> :.......................•--..............•............... -672-- <br /> (Complete In Triplicate) Permit Na. Z�....... <br /> ..........1­............­­.......................... <br /> ..................... .........."I............ This Permit]Expires I Year From Date Issued Doti Issued ........ ........... <br /> Application is hereby made to the Son Joaquin Local 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/L)DqATION <br /> ..t--��',_CEN SUS TRACT ._-_------------------ <br /> Owner's Name ........... ..........I.................................r............ ...... .....Phone ............. ........... ......... <br /> Address __-_.--•-•- .......... ....... ............ City .......re_4_�_ : ...----•-----_.......--•--.............. <br /> Contractor's Name ---- . ---..... - ­-­-/Z1 ------..........License # Phone <br /> Installation will serve: Residence 01Apartment House 0 Commercial OTroiler Court tj <br /> Motel 0 Other........... -------------- ...... <br /> Number of living units:..... ------ Number of bedrooms ... G�orba'g' b Lot size ----1 :................. <br /> Water Supply. Public System and name ................................................... <br /> ..................................Private <br /> Character of soil to a depth of 3 feet: Sand 0 Silt 0 Clay EJ Peot.0 :'Sandy Loom 0 Clay Loam <br /> Hardpan 0 Adobe 0 Fill Material ........:L If yes,type................. ............ <br /> (Plot plan, showing size of lot, location of system In relation to welli, building's, etc. must. 6 placed on reverse aide.} <br /> e.) <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) If <br /> PACKAGE TREATMENT [;] SEPTIC TANK Licfuid Depth _:�6--------- <br /> A -1 ' ,r <br /> .4000 ... Material_.. No. Compartments ...:_2 <br /> Capacity TY4444, 7, ft............. <br /> Distance.to nearest. Well ...... ------------------Foundation -----L.(x ...... Prop. Line ..... ............ <br /> LEACHING LINE No. of Lines _______________ Length of each line..........110........... Total Length ...... ........... ?b <br /> P., <br /> V Box .....I------ Typejiltor Material'IlLfl ....Depth-Filter Material.......zZI................................ �6- <br /> .. . <br /> Distance to nearest: Well J.,o --(......... <br /> ' Foundation ,—O&r............ Property Line .............. <br /> -1....... Diameter ...;nP��...... v ..... lied Yes <br /> SEEPAGE PIT Depth N r mber _......3.............: Filled <br /> N a (:I <br /> Water Table Depth ----------••••--......••••-•....................Rock Size •----------------I.._.........._ <br /> Distance to nearest. Well ­4t> t <br /> ---_---_------------Foundation ... rteU'-:-, .._..._..... Pro . Line <br /> p <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .............. .............. Date .......................:............11 <br /> SepticTank (Specify Requirements) ............. .................................... ................................................................... ........... <br /> DisposalField (Specify Requirements) ------_--------_..................... ...... ...........m...........­........................................................ <br /> ........................... -----------•-•------------- ....................I........ ........................................................ --------------I--------- <br /> -------------------------- -------------------------------------------­_­­------ ------------ --------------- ........................................... ................ ................. <br /> (Draw existing and required addition an reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Lecal.HeallhDistrict. Ham* owner or Ilcew <br /> sed agents signature certifies the following: <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 /> as to become subject.to Workman's Comperiiarson laws of California." <br /> Signed <br /> _�------ Owner <br /> ------------------------------------- ------------------------_- <br /> By ......... . <br /> - -- - --------- --her tha ----------------*--------------------------•-------- ------- Title <br /> (if other owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED By ...........9/10•............................I---------------------------------------------- DATE --------------- <br /> BUILDINGPERMIT ISSUED ------------------------------------ ------- --------- ---------------------------------------------------DATE ... ....................................... <br /> ADDITIONAL COMMENTS ---------------------­.­.........................I.....................1­ ­ W ...... <br /> ..........­1----------_--- ------------------------------1-1-1-­------------_--­--I-------------------------------------­*----------- --­......­­.......................*........... <br /> --------------------------------- ---------­-- -----•-------•--....----------- ----•--- ------- <br /> -----------------------I-—------------ _­­--- --------- ---------- ------------- ­---------- ---­­­­----------------- ........... ----------------- <br /> 40 ----------- <br /> FinalInspection by. .............et .......................... ----------4................... <br /> ­­..................................Date ........ .......... <br /> EH 13 2h 1-68 Rev. 5m 41 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />