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FOR OFF-ICE USE: <br /> OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. <br /> i <br /> --------------- --------------------------------- (complete in Triplicate) <br /> Date issued <br /> ----------I.—----------------------- ----- ---- This Permit Expires I Year From Date Issued <br /> .... . -----I <br /> - -------- 000 <br /> -------------------------------------------- ........... <br /> 141 <br /> V-VT-7,�ivl 1 11 1! 1!1 1 1 1 construct and install thework herein <br /> '40 permit- <br /> 0Z- 6caI-'HedIth,,16!F I Ic 0 a <br /> Application is hereby made to the Son quin L 11 �isjiag Rules andlegWatio5nis: <br /> described. This application ii made-incompliance wlth,Coun -Ordinance.No.-549'and.'6, <br /> CENSUS T(ACT -------------- <br /> __CE t <br /> �rn <br /> JOB ADDRESS/LOCATION <br /> --Ph ne <br /> ----------------- <br /> - -------------- <br /> Owners Name ---------- ------- ty ------------------ <br /> _ ____ - - '7�-- ------------ --- <br /> Ci ------ ----- ------- ---- <br /> License --- Phone _f��6 <br /> 'Address - ------------------ <br /> Contractor's Name -------------- - I :E]Trailer Court <br /> Apartment House IE3 Com mercia <br /> ------------------ <br /> ------------ <br /> motel [],Other <br /> Installation will serve: Residence X %J k <br /> �K der Lot'Size ------------------------ ------- <br /> its: ----- Number of bedroom --Garbage Grin <br /> Number of living un Private <br /> J ---------------- -------------------------- <br /> ame ------ <br /> ---- ---------------:�7 <br /> Water Supply-. Public System and n -, " "s I gi <br /> I Si! ❑ Clay M Peatl­j Sandy Loom ❑ CIO .Loam.0 <br /> Character of soil to 0 depth of 3 feet: Sand'[] <br /> A <br /> I Material ------------ If Yes, type ---------------------------- <br /> Hardpan El 'Fill <br /> L buildings, etc. must be placed on reverse side.) <br /> Zeafioniof syst,em.in relation ta wells, <br /> I(Plot plan, showing size of lot, '%, I L % <br /> -ittea if public sew( <br /> N: I 'I-, t <br /> <!P�A I �r is available within 200 feet,NEW INSTALLATION: (No septic tank pit t- Depth ---Icy- .............. <br /> I —"',%s4 A ------------------ Liquid <br /> PACKAGE TREATMENT SEPTIdTANK: ize. <br /> Compartments -----71.......... <br /> N o. Of <br /> Capacity Type�a-64� --_Material <br /> I ;J U _- -t I Foundation ----------- Prop. Line -------- ------ <br /> Distance <br /> ------- -----4------ <br /> Fou <br /> Distance to nearest. Well ------ --- ---- ---- 10 <br /> No.I of Lines ----- - ------ Total Length -1 -00----------------- <br /> LEACHING LINE ------------- L n th a e.�hine---1W- ------- Material ------ ---------- ------ <br /> r. <br /> Ty. ilter M te ia ---------Depth._Filter Mate <br /> -D' Box-------11/.� pe-Fi-Iter.M 11 r <br /> ---- <br /> --------- Property Line ---------- <br /> Distance to nearest., Well - d_ ---`--------- FoundationYes NoO <br /> Rock Filled . e <br /> Depth ---- Diameter Y,3 <br /> Number -------- <br /> SEEPAGE PIT -- ---- -----I <br /> Water Table Depth -------------------------------�r------- -------Rock Size —------ <br /> 1b. 7P7:��----------Foundation Prop. Line ---------------------- <br /> Distance to neare*st-. Well -------/9------ <br /> 1 1 _ Date ----------- <br /> REPAIR/ADDITION(Prev. Sanitalion Permit ----------------- - ---------------------------- <br /> Septic Tank (Specify Requirements) ------- -- ------------------------------------------------------------------------- <br /> I ements)l ------------------------------------------- -- ---------------------------------------------------------- <br /> Disposal Field JSpecify Requir <br /> f i ---------------------------- ------------------------------------------------------------- <br /> --------------- ------------- --------------------w--------------- <br /> ---------------------------------------------------------------------------------------------------------- - <br /> ---- ------k---------------- <br /> (41 <br /> ----------------------------- - ------------------------ addition on reverse side) <br /> (Draw existing and requiredn accordace with Son Joaquin <br /> atioand the work will be done i <br /> I hereby certify that I have prepared tntsq,P plicRu <br /> sed <br /> nlationsthat of the Son Joaquin Local Health District.nHome owner or licen- <br /> County ordinances, State Laws, and Rules,,and <br /> sed agents signature certifies the following: <br /> the work for which this permit is issued, I shall not employ any person in such manner <br /> -.1 certify that in the performance 0,f 4 <br /> Is Cornpensi6ietbn laws of California." <br /> as to become subject to Workman <br /> Owner <br /> ......... ----- ----------------------------- <br /> Signed <br /> -------- ----------- ---------- <br /> itle <br /> ------ -- ------- <br /> By <br /> (if oth an owner) <br /> FOR-DEPARTMENT USE ONLY <br /> DATE ------------ <br /> --------------/ <br /> APPLICATION ACCEPTEDByzl. .&47---�_4--------- ------------DATE -- ---------------------------------------- <br /> 5SUED ------------------------------------- -- ----___/---------r <br /> 1��------- ------------- <br /> BUILDING PERMIT 1: ------------------ ---------------------------- <br /> ADDITIONAL COMMENTS ---e,�...... --- ------- ---------------------------------------------------------------------------- <br /> ------------------------------------ ------------------- __­---------- <br /> ------------ ----------------------------- -------------- <br /> ------------------------=--------------------------- ----------------------------------------- ----------------------------------------------------------------------------- ------ ------- <br /> ---------- ------------------------------------------- --------------------- -- <br /> - <br /> ------ - ----- -- -------- <br /> ... ---------------- Date <br /> y: --------------------- <br /> Final inspection b <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F. H_ 9 1-'68 Rev. 5M <br />