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FOR OFFICE USE-. APPLICATION F*R SANITATION PERWY Permit'No. <br /> ...._.------•---........ ............ ------------------- fcompleto in Triplicate) <br /> h,t,r1thTk Yhbein <br /> --------------- -----------------­----------11----------- This Permit Expires I Year From Date issued <br /> ---------------- - <br /> ----------•-----------------I------ <br /> le so Joaquin Local Health District for a per'mit io construct and insfa I the work he-ein <br /> Application is hereby made i to 0 made in complianc.e.wIth County Ordinance NO. 549 and existing Rules and Regulations. <br /> described. This application s mo <br /> I CENSUS TRA 9.3-----------_--- <br /> ----------------------- <br /> OC TION ... ...............--------- -- ------------ -------- <br /> JOB ADDRESS/LOC TION , . ...39�_ <br /> Owner's Name ......... . .... I----------- -- -- ---- -- -------------------- - --------;---------->_D_ ----------------Phone---------------------------- <br /> -------- .... city <br /> ------- .....I - -------------- ----- <br /> Address ----------- <br /> U --- ------ - ----- --------- jc�ense #.2.!E Phone .......I....................... <br /> Contractor's Name ------ - ------ <br /> Installation will serve: Residence Apartment HouseO Commercial oTraile�r Court 0 <br /> Motel []Other ---------------------- ---- Lot Size .. ..... <br /> Number of living units:..._..___- Number of bedrooms __,3 Grinder............ <br /> Water Supply- Public System and name .... ---------------_---------- -----------------------------I--------------------------I..................private <br /> -Sandy Loam* Clay Loom <br /> Character of soil to a depth of 3 feet: Sand❑ S*,Ito, Clay 0 peat[] <br /> Hardpan [3 Adobe El Fill Material -------- If yes,type---------•---•••------- <br /> (Plot plan, showing size of lot, location--of-systemr-ln-relation-to-wells; buildings, etc.'must be placed on reverse side.) <br /> septic tank or seepage pit permi&d-if,public sewer is available within 200 feet)NEW INSTALLATION: (No se ' " . _. . 1, , - Liquid Depth ----------- ........ <br /> PACKAGE TREATMENT [ I 6EPTiCfANKJ ) '. Size----------•--• I------ ------ --- <br /> Na: Compartments ....... .............. 91N <br /> capacity ------- ------- Type --- ..............I--- M-aterial-------------- <br /> -,:-Foundation ----------------_---- Prop. Line _-_---_-------- <br /> Distance to-nearest: Well --------------------------------- 5\ <br /> ------------------------ Total Length ----------------------------- <br /> LEACHING LINE No. of Lines -------------- Length of each line <br /> ----------------- <br /> 'D' Box ----- ...... Type Filter Material ;-------------------D.epth Filter Material <br /> ---•...................... <br /> Well ....... ----------------- foundation ------------------------ Property Line --------_-------------- <br /> Distance to nearest. <br /> ... Number ---------------------------- Rock Filled Yes ❑ No <br /> SEEPAGE PIT Depth ----_------------- Diameter . ..Rock Size ........................I-..-.-- <br /> Water Table Depth ---------------------------------------1------ ------- ------------ Prop. Line .................... <br /> Distance to nearest: Well --------- -------------------------------Foundation <br /> Dote .................................. <br /> REPAIR/ADDITION(Prev. Sanitation Permit -------------------------------------------- ......... <br /> Septic Tank (Specify Requirements) --------- ------------------------------------------- ................ <br /> --- - --- ----- <br /> Disposal Field (Specify Requirements) ----ct-cle-le--- <br /> ---- ------- <br /> I cy-------- -----_----------- <br /> ----------------_ <br /> ---------- <br /> ------------------------- ............ <br /> "-.---• ------- ----------- -----_.... (Draw existing and required addition on reverse side) <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 Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or [icon- <br /> sod agents signature certifies the following: k for which this Permit is issued, I shall not employ any person in such manner <br /> "I certify that in the performance of the work <br /> as to become subject to Workman's Compensation laws of Cullfilrnid-­ <br /> Signed ---------------- ------------------ --------- Owner <br /> c��--- -----­--------- ------- ----------- <br /> Title J <br /> By -------------_-- ------------- ---------- - ----------- <br /> (If-'oW-r than owner] <br /> F R DEPARTMENT USE ONLY <br /> .... ................ <br /> DATE <br /> rl ACCEPTED APPLICATION ACCEPT'DBY -- -- - <br /> - ----------DATE -------- <br /> BUILDING PERMIT ISSUED -------------------------------------------------------------- --------------------------------- <br /> ADDITIONALCOMMENTS -------------- ------------------------------------------ -------------------------------------- <br /> ---------­-------------------- --------------------------------------------------------- ---------------------- ------------------------------------I-------------- ---------­ ------ -- ------- <br /> .................................................. ......I...............I-------------------------------------------------------------------------•----------------------••--•-••--------- <br /> -----bate <br /> ------------------------------ ---- ------ <br /> ------------ <br /> ..... ---------------- -y -------------------------------------- <br /> ------------- ------------------ <br /> Final Inspection by-, _-, -------- - ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1_'68 Rev. 5M <br />