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L FOR OFFICE USE: Ar,�CATION FOR SANITATION PERMIT 7v 9fv <br /> ----- -------- complete in Triplicate) Permit No. - . �Psp&/ <br /> - -------- Date Issued o�� <br /> This Permit Expires I Year From Date issued <br /> ............ .........—------------ -------- <br /> L----- - ------------ -- <br /> Application is hereby made to the Son Joaquin Local Health District for a perm�it to construct and install the work herein <br /> app is made in complianc withXnty Ordina e No. 549 an existing Rules and Regulations: <br /> ,scribed. This c1pr V I a 0 <br /> e 19, 1 a - NSUIS TRACT ------------------------- <br /> ...... ....eA -------CE <br /> efcv eel/ loly <br /> JOB ADDRESS/LOCATION __--- <br /> -----Phone 1019 - - - <br /> -- ------------------------------------------- -----------V <br /> owner's Name -------- - ----------city ------------------------ <br /> L /SOC <br /> Address ,(/ --- ---- Cn/XP------- <br /> License Phone gae <br /> Contractor's Nome <br /> Installation will serve: Residence <br /> El Apartment House-0 Commercial OTrcliler Court 0 <br /> L Motel 0 Other ------- --------------- <br /> Number of living units:.-_-_.--------- Number of bedrooms ___-__---Garbage Grinder Lot Size <br /> Private (� <br /> L Water Supply: Public System and name d---------- -Silt-t-,0------Clay-y---E❑ <br /> *]-----Pea-t El Sandy Loom 0 Clay Loom-0 <br /> Character of soil to a depth of 3 feet: Santw S " <br /> Hardpan E] Adobe 0 Fill Material ----- ----If yes,type -------------------- <br /> -- <br /> Lon reverse side.) <br /> (plot plan, Showing size of lot, location a system elation to wells, buildings, etc- must be placed <br /> (No septic tank or seepage pit permitted if public sewer is available within 200 feetl A <br /> LNE�v lNsTALLATl0N: Size.-#?>e 0---- ----- Liquid Depth __,'/15�--------- <br /> PACKAGETREATMENT [ I bEMICTANK11 --- -- --� 0Compartments 1partments ------- <br /> 7. . <br /> Capacity Type,0e_&V__;r_r Material <br /> i� _/ .-Foundation ----- Prop. Line i�------------- -- <br /> . .. .. <br /> 6. Distance to nearest: Well ------- ... each/ <br /> ------------- Total Length _;7_0------------- <br /> LEACHING LINE No. of Line, ..../------- ----- -- Length a ea me.- _6 ------------------------- <br /> D' Box ------------ Type Filter Material ---Depth Filter Material <br /> Lnearest: Well ----- -- ---- foundation/ ------- -- Property Line <br /> Distance to nearest: Well -- ___ Number Rock Filled Yes 0 No (I <br /> SEEPAGE PIT Depth -------------------- Diameter Rock Size -- ----------------------------- <br /> 6. Water Table Depth - --- ------------------------------- ---------- <br /> Distance to nearest: Well ----- ----- --------- ---- -------------Foundation --------------- - Prop. Line --------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ----------- ------------------ ------------ Dote ---------- ------------------- ------------------ ­ -- - <br /> L. Septic Tank (Specify Requirements) - ------------------- ------ -------- ----------------------------------------- ------------------------ <br /> Disposy I Field (Specify Requirements] ----------I------------ -2-0 <br /> fo ei� ------------------------- <br /> law -----tAl-S------------ -----------I------------------- - --- ---------------------------- <br /> -- - - -- _ -------­--------------------------;----------- reverse side) <br /> ------ ---- ----- -- (Draw existing and required addition on accordance with Son Joaquin <br /> this application <br /> I hereby certify that I have preparedand that the work will be done in County ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> I L "I certify 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 War an,s Compensation laws of California." <br /> Owner <br /> Signed -- Title "--------------------------------------------------- <br /> Y <br /> -------- ------- ---------- <br /> -- ---- --------- ICZ <br /> By------ - <br /> L 5i <br /> (if other than owner) FOR DEPARTMENT USE ONLY <br /> DAT -L®------- Y------ <br /> LAPPLICATION ACCEPTED BY - ------------------------------- ----------- ------DATE ----- -- --------------------------------- <br /> BUILDING PERMIT ISSUED _ -- _-------------------------------- ---------------------------------- <br /> ------------------------------ -- ------ ------­-- ----- -- ---------- -------------- --------------------------- <br /> ADDITIONAL COMMENTS --------------- ------------------- - --------------- <br /> ----------------- <br /> 6 <br /> ------------------- -------------------- <br /> _---I-- -------------------------------­------ ------------------------------------------------------------------------------------------------------- ------------------------- -------------- ------ <br /> - - -- ------------------------ --------- ------------------------------------------------------- ------------------ ---------------------------- ------ ------ <br /> ------ -- ---------- <br /> - -- -------------------- ------- '-------------- <br /> -a .Date --- ------------ -------------- ----- <br /> Final Inspection by: ----- --------- ---;X-1- <br /> L SAN JOAQUIN LOCAL HEALTH DISTRICT <br />