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4V <br />FFICE USE ­%TION'POR SANITATION PERMIT fF <br />Permit No- ------- ------------------- <br />(Complete in Triplicate) Date issued <br />I This Permit Expires 1 Year From Date issued <br />—App—ppli—icafion 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 mode in compliance with County Ordinance No. 549 and, existing Rules and Regulations.. <br />CENSUS TRACT -------------- ----------- <br />-------- -- -------- ---------------------- <br />JOB ADDRESS/LOCTIO - - ------------ <br />Phone---- ------------------------------- <br />Owner's Name � ------- city ------------------------------------------- <br />--------------------------- ------ - <br />Address Wy ------ <br />Phone <br />License # -S-V-7 <br />Contractor's Name -- -- ------------ <br />-- - -------- - <br />Installation will serve. Residence partment House f`l Commercial ElTroiler Court 1E] <br />Motel F-l Other ---------------- ----------------------- <br />Number of living units. ... Number of bedrooms --- � --- Garbage Grinder ------------ Lot Size <br />iPrivate Ej <br />Water Supply. Public System and name <br />. <br />Character of soil to a �epth of 3 feet: . Sand'E] Silt C1 Clay F-1 Peat E] Sandy Loom -F] ClayLoam E] <br />Hardpan F1 Adobe�< Fill Material ------------ if yes, type ---------------------------- <br />(Plot plan, showing size of lot, location 6f -system in relation to wells, buildings, etc, must be placed on reverse side.) <br />NEW INSTALLATION:, (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br />Liquid Depth --------------- ---------- <br />PACKAGE TREATMENT f I SEPTIC TANK![ I Size ------------------------------------------------ <br />Capacity --------- ----------- Type -------------------- <br />Material---------------------- No. Compartments --------------­----- � <br />Distance to nearest: Well ------------------------------------Foundation---------------------- Prop. Line -----------------­--- <br />LEACHING LINE ]j No. of Lines ------------------------- _ Length -of �ach line --------------------- ------ Total Length ----------------------- <br />-------------------- A -------- I --------- <br />'D' Box ------ ----- Type Filter Material -------------------- Depth Filter Material <br />Distance to nearest. Well ------------------------ Foundation ------------------------ Property Line ----------------------- <br />SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ----------------------------- Rock Filled Yes El No (3 <br />WaterTable Depth ----------------------------------------- ------ Rock Size ---------------------- --------- <br />I <br />Distance to nearest. Well ---------------------------------------- Foundation -------------------- Prop. Line --------------- ------ <br />IDate -------------- ------------------- <br />REPAIR/ADDITION (Prev. Sanitation Permit# ------------------ -------------------------- <br />I--------------- .... --------------------- <br />Septic Tank (Specify Requirements) ---------- - ------------------------------------------- ------ - <br />-------------- ----------- <br />Disposal Field (Specify Req'u'irements)rte...... <br />-------- ---- -------------------------------------------------------- i ---------- <br />i- ----------------------------------------------------------- <br />----------------------- ----------------------------- <br />--- --------------- -------- P"4-' <br />(Draw existing and required addition on reverse side) <br />nct and e <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 Lowi,"and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br />sed agents signature certifies the following: <br />u <br />"I certify that in the performance of. ,t)e work for which this permit is issued, I shall not employ any person in such manner <br />as to becouW subje5t to XWo4an'y f California." ompensatio_91 Vws <br />Signed <br />By--- ---------- - --------------------- <br />(If other than a' <br />i <br />Title <br />DEPARTMENT USE ONLY <br />APPLICATION ACCEPTED BY ------ - --- --- ------- ------------------------------- <br />BUILDINGPERMIT ISSUED --------------------------------------------------------- ------------------ ------------- <br />ADDITIONOM EDITS ---------------- ------------ -------------------- ---- ---------- ---- -- ----------- <br />7 --------- ------------ <br />----------------- - - J_ -------- -- --- --- -- --------------------------------------- <br />------------------ ---- I ----------------------------------- - -__________________S_____.___-_____________________-- _-___-.__-_.____.___- <br />------- <br />-----------------Y!------------------------------------------------- --------------------------------------- ------------------- - -------------------------------------------------------------- <br />Final Inspection by: -------- --------------------------------------------------- ------------ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />E. H. 9 1-'b8 Rev. 5M <br />DATE ---------- <br />--------DATE --- --------------------------------------- <br />------------------------------------- ----------- --------------- <br />----------------------------------------------------------------- <br />------------------------------------- /I ---------- --------- <br />7 <br />---------------------------- --------- --------- <br />-------------Date -------- fl 7 <br />