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OFFICE USE- <br /> ............. <br /> Date Issued <br /> ........tt' APPLICATION FOR SANITATION PERMIT <br /> l rnplefe In Triplicate) <br /> Permit it No. <br />................... .............. ....... ..... ........ This Permit Expires I Year From Doh 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 mode in compliance with County Ordinance No. 549 and existing Rules and Regulaflons- <br /> JOB ADDRESS/LOCATION L---------------&Z-9.1Z.......... _0.....CENSUS TRACT ................... <br /> Owner's Name .......... o-o-L-A......... X vv-,_:1 _-------.........................................:................Phone <br /> Address .......---9•• ALL-e.y_n...............•-•_...:city .CS.T-4U.ta......... .................. -_----_--_--------- - <br /> Contractor's Name ----------0-KAD-V........... -.-•---•.... .License Phone <br /> Installation will serve: Resf dence{Apartment House 0 Commercial OTraller Court C] <br /> motel 0 Other--•-••--•`-•.................... <br /> Number of living units:.... Number of bedrooms -.,S---..Garbage Grinder _.^V. LotSlze 44 L P-,e t--.- <br /> Water Supply: Public System and name ................ .._Private................................................ <br /> ....................­­..... 0 <br /> Character of soil to a depth of 3 feet. Sand 0 . Silt 0 Cloy 0 Peat 0 Sandy Loam a Clay Loam <br /> Hardpan Pg Adobe 0 Fill M6terlal ............ If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells,' buildings, etc. must be p-Geed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer Is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANKSize.f I <br /> ....... 2 qtirt....... Liquid Depth <br /> Capacity /2VOIOL Type P.1'r_.:CA9'j_Material._C'D_hA Ndf No. Compartments __0..___. .. <br /> Distance to nearest: Well .........6.Foundationa. lp_----------- Prop. <br /> LEACHING UNE E No. of Lines ..Aff. 07___ Length of each line--------# <br /> Total Length ... <br /> V Box .../----- Type Filter'Material j?'I......Depth' Filter Material ------- ............... <br /> ...... Foundation 4 <br /> ��",Di stance to nearest: WeI149P�� unclotion .............. Property Line . ........... <br /> SEEPAGE PIT tpth _._A6Vr_A:rD1ometer­ J %,PLO <br /> Number .....0................ Rock Filled Yes* <br /> Water Table Depth .­­------------------------------------------Rock Size ........ Prop. Line <br /> -------------- <br /> Distance to nearest: Well ....... ....... 0 <br /> -40ec--P 0......*�or......Foundation .......... <br /> OEPAIR/ADDITION(Prev. Sanitation Permit# ......*...................................... Date .................................. <br /> Septic Tank {Specify Requirements) ............................ ......................................... ........... .......................... <br /> ........... <br /> Disposal Field (Specify,Requirements) ............ ....... .................... ...................................................... <br /> -------------------------- <br /> d,.......................... --------- ................................. ......... .......................... .............I---------- <br /> "41 1 <br /> ----------- -------------------- -------I- -------------------------------- ........ .......................I............ ............ .................................. <br /> raw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and-that-thv-work­wIII-be done In-accordanc*-w1fh-San Joaqulln-,__� <br /> County Ordinances, State Laiki, and Rules and Regulations of the Son Joaquin Local Health,District. Home owner or licen- <br /> sed agents signature-certifies,the following: <br /> "I certify that in-theperformance of the work for which this permit is Issued, I shall not employ any person In such rnanner <br /> as to become'subie to Workman' , Compensation laws of California." <br /> Signed <br /> 4-CAUV(—-------------------------------- Owner <br /> ZBy �_Z-A--- ------—� ...A4_c)­�----- --------- Title ....... <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .--------- -------------_------ <br /> BUILDING PERMIT ISSUED -------•------------------------------ ......................... ..................DATE ..................... --- <br /> ................... <br /> ADDITIONAL COMMENTS -----—------------------ <br /> ............ ----- --- ............ ------------------- <br /> - ----------------I----------- <br /> -------------------- ---- <br /> ---_------- .......................... -----------I-------------- --_------------- -------------------- <br /> ---------------------- /& ------.-.-.-.-..--..--..--.-..--.-.-.-.-.-­--­-6---------------------------------------------------------.-.--.-.-.-.-.-.-.*.-.-.-.-..--.-.-.-..-.--.-..-.--.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-..---------*-*----------------- <br /> --* ......... <br /> -------- <br /> Final Inspection by: ------------.................... ---------• .................. ---------Date -/ -7?........... ............EH <br /> 13 2h 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />