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FOR OFFICE USE: <br /> APPLICATIOWFOR SANITATION PERMIT <br /> ........ ------- ......... <br /> ............. 10- -1 1.� V Permit No.69-n.5�;I.. <br /> (Compleftin-Triplicafhol <br /> ---- ---------------- <br /> i ------_-------------_ ---/96 This Per Date Issued <br /> mit Expires I Year From batis Issued <br /> A "cba''on is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> L citscried This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCA�PN ....... . ..... . <br /> ,T r - --- 7... i---------.-.-CENSUS TRACT ......................... <br /> Owner's Name _'e.t <br /> ....... Phones. <br /> Address �fz; <br /> ---- -- ------- -------------------------------- . ................... <br /> /J(1?J94%,?,Phone <br /> Contractor's Name ....... _10...... .............-S.-4........Lice <br /> Installation will serve: Residence [j Apartment Houseo Commercialif3*raffeir Court E] <br /> l <br /> iMotel [j Other-------- ------------------------------ <br /> Number of living units:.0 Number of bedrooms ... .Garbage Grinder ....4!n.. Lot Size <br /> Water Supply: Public System and name .............. - ---------- --------------Private <br /> ------ - ---- ------------------------------------------- <br /> Character of soil too depth of 3 feet: SondE] Silto Clay SandyLoami-] Clay Loom..0 <br /> Hardpan E3 Adobe fV Fill Material ---- If yes,type ............................ <br /> (Plot plan, showing size of lot, location of system In relation to w4lis, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION- (No.septic Jk or seepage pit permitted if public seweir A available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC ze--- ---gr ....... <br /> ..... Liquid Depth <br /> Capacity Type i07-Matirial. ^,c._vWANo. Compartments ..... <br /> 7e . �,I;�1�, � j <br /> Distance to nearest: Well --------:501_.11____ ______------Foundation ........... Prop. Line ...Is ....... <br /> LEACHING LINE No. of Lines -----10 ---/.11 Length ofr7 line-----c5�10_0 5; <br /> P--- ------------ Total Length F <br /> ............ <br /> Box Material ------ <br /> 4�.. Type Filter Material S .....Depth Filter M _/...... .............. <br /> 0� <br /> Distan /to-nearest: Well -----�5V. ........ Foundation I.A.9-!..... --- Property Line <br /> ............. <br /> SEEPAGE PIT Depth --- Diameter .23........ Number ...___/................ Rock Filled yes R--iv <br /> Water =2 <br /> Table Depth --- ftr------------------------_Rock Size ....4;. <br /> Distance to nearest: Well ..../R.A_1....................Foundation Prop. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ............................... <br /> I <br /> SepticTank (Specify Requirements) ............... ---------------------------------------------------------------------- ----------------------­--­....... ......... <br /> I <br /> DisposalField (Specify Requirements) .............................................................................. ...................................................... <br /> ........................... .....................­ ­ ------- -------------------------------------------------------------------------- ------------------- .................................. <br /> ----------- ---....----------------- --•------I--- - <br /> - ...........:---------- -------------------------------------­-----------­---I............ ----------- ........................ <br /> V[Draw existing and required addition on reverse side) <br /> I hereby codify that I have prepared this application and that the work will he 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 licen- <br /> sed agents signature codifies the following: <br /> "I codify 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 become subject to Workman's Compensation laws of California." <br /> Signed .............................------------ f ...--- Owner <br /> ---- <br /> By ........... ---­------------------ ---- ------ -—------- Title --- 4�� .................................... <br /> (if other than owner <br /> �j <br /> FOR DEPARTMENT USE ONLY gg <br /> APPLICATION ACCEPTED BY--- <br /> --------------- - -- ------­ ................. DATE ... 7�: <br /> BUILDING PERMIT ISSUED /---_--_-----_-------_-- --------------------_­ ..DATE _...................... ...... .......... <br /> ADDITIONAL COMMENTS ........ ........................... -------- ................ -._....----------- <br /> r--- --- ---------------------------------------------- ------ ....... ------------------------------------- ---------------------------------------------------------------------------------- <br /> I <br /> --------­---------------- ............................ ............................ ................. -------------- ..... ....................... ------------------------------ - ------ <br /> .... ----- ;2�---------- <br /> ------ ----------- <br /> ---- ---------------- ----- ---------------------------iinallnspecion by: _ --- !V � -- - -__ <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br />