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FqR OFFICE USE. i <br /> M��/ f//', r-8 APPLICATION FOR SANITATION PERMIT <br /> ......... ...................... Permit No. ........... 4, <br /> (Complete In Triplicate) <br /> ........................ <br /> ...............1­­F!**&&*­E-1..0*..Mff*Z1............. This Permit Expires I Year from Date Issued Doti <br /> Application'is hereby made to the Son Joaquin Local Health District for a per,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, i <br /> :3 0 .......... ......S.�j ­-CENSIJs TRACT .............. <br /> 'JOB ADDRESSAOCATION ,_ .......it.x........ <br /> Owner's Name ............ -Y-C--V-1c.H- ... .. ... ..................:................Phone <br /> Address ..... ............. ...........City .......................I................--- ............................. .. <br /> Contractor's Nome .... ........%211... ..........License # Phone ... <br /> Installation will serve. Residence ra Apartment House fl Commercial OTraller Court C) <br /> Motel Q Other............ <br /> Number of living unitst-1 Number of bedrooms age Grinder ............ Lot Size cl'.­....... <br /> WaterSupply.,Public System and name ......._­......1-......................................................................................Private <br /> Character of soil to a depth of 3 feet. Sand Q Silt 0 Clay El Peat C3 Sandy Loam (3 Clay Loom 0 <br /> Hardpan 0 Adobe Fill M6terlal -.........If yes,type ............... .......ev. <br /> )Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse s1de3 <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT O SEPTIC TANK Size................................................. Liquid Depth .......................... <br /> Capacity .........-........ Type ......I.............. Material.......... ........... No. Compartments ...................... <br /> Distance.to nearest: Well ........... .... ..................Foundation ....................... Prop. Line .....*....... <br /> LEACHING LINE No. of Lines .........il......7-- Length of each -line....... Total Length .....Z4.r..!.........V1. <br /> V Box .... ... Type filter Material .4.,.j0CWKPepth Filter Material ........... ..................... . <br /> Distance to necirest.. Well ...O. ?........ Foundation .... Property Line .........In <br /> SEEPAGE PIT Depth .................... Diameter ................ Number ............. ........ Rock Filled, los E) No (3 <br /> Water Table Depth ............ ...................................Rock Size ................................. <br /> Distance to nearest; Welt ........................................Foundation ........... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..... . ......-........ .......... Date ...........................-:.....I <br /> Septic Tank (Specify Requirements) ............ ........ ....... .......................... ........ ...................... .................................... <br /> (Specify Require L <br /> Disposal Field mentsl .................. ..................................................... ...................... .............. ........ ........ <br /> ............. ............................. ............................ ........................ ................................................. .........................11....... <br /> ............ ------ .....................•----....................... ................ <br /> ------------------ ............................ ..................... ...... ....... <br /> (Draw existing and required addition on reverse side) <br /> 1 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 Hoal*District. Home owner or liven• <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 beco�m Asubjec ork an' Compensation a Of California.'* <br /> Signed ---- -- owner <br /> ....... ... . .......... <br /> ............ .......... <br /> . ............... yitle ........... ........................... ...... <br /> By --------------- . . ........ ..... <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ --- ---- ---------------------------------------------- DATE . .......... <br /> BUILDINGPERMIT ISSUED ....... ------ ........ ............... ............................... ......... ...........M_._DATE _.......................................... <br /> ADDITIONALCOMMENTS ....... ...____..........................._......... .......................... ....................*......*........-.......................... <br /> ........... .....................__.................................................................................... ....&... .....................­­................................ <br /> ................................... . .. ..... ._..-----------.........-•..._...--—— ........ ....... ---------------------------------- <br /> ---------------------------------- ---------//.o!.7,-0._.`�_ <br /> - ----------- -------- ......Yr7. f----- --7 <br /> Final Inspection by: .... .......... .. ..... .........................Date' ---/_ .7� - <br /> EH 13 '24 1-68 1.ite At HEALTH DISTRICT 8/7h 3M <br />