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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ........................................................ permit <br /> ......................L............... Doti Issued <br /> ....... ...........I——.............................I This Permle ExpIrss I Year front Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a Permit to construct and Install the work herein <br /> described. This application Is made in compliance with County Ordinance NO'. 549 and existing Rules and Regulations; <br /> JOB ADDRESS/LOCATION . ..........................CENSUS TRACT ..................... <br /> Owner's Name .../V r. 7�.ffc!'ry....../10, ......................................................Phone <br /> AddressA.....Mr.,w- k.........City ...X�.W.&,r.A.......... ............... <br /> Contractor's Name ..................­........License Phone <br /> ce House IJ Commercial C3Trollw Court 0 <br /> Installation will serve: Residen <br /> MbtolOther.------.•.......:....•••...;............. <br /> Number of living units-....1...... Number of bedrooms ...I.....Garbage Grind4it ..............Lot Size <br /> ............................... <br /> Water$upply3 Public System and name ........................ ................................ ............................................. <br /> Character of soil to a depth of 3 fest: Sand t3 Slit E3 Clay_© Pact E3 Sandy Worn L*om 13 <br /> -Hardpan;]fl� AO*Ve 0- I aw-motorial ............if yes,type............... ............ <br /> Tri�eIWW to <br /> (Plcyf,--,rai%- k�;,A71ng size of lot; lac6tioniof sysie"II"_ wells, buildings, eV_ must be placed on reverse side.) <br /> '%.p 0 J . <br /> NMN INSTALLATION: (No septic tank oi,seepage pit permitted if public sewer Is available within 200 feet') <br /> PACKAGE TREATMENT .[ ] SEPTIC TANK I.]_---size---_.......................................... Liquid Depth .................* ....... <br /> Type .................f.. Material, .... No Compartments 1 <br /> Capacity ......... . Co pattrr4 ... . ......... <br /> Well ....................Foundaticiii ......................Prop.line ...................... <br /> Distance.to nearest- ............... <br /> LEACHING LINE No. of Lines ..................7...-: Length of each line................._.__....... Total Length ........................... <br /> V Box ......... Type filter Material . Depth filter Material ...................................I.......... <br /> Distance to nearest; Well ........................ Fo`616Jarloh ......................... Property kine ........................ <br /> SEEPAGE PIT Depth ......:............. Diameter .......... Number ............................. Rock Filed Yeis 0 No 0 <br /> Water Table Depth ..:...........I... ......I....................Rock Size .........:................... <br /> f <br /> Distance to nearest- Well ........................................Foundation. ...................... Prop. Line ............. ...... <br /> REPAIR/ADDITION Wreit.-Sanitation Permit .... <br /> ....... ............ Date ._.........:...............:....A <br /> Septic Tank (Specify-Recivireme _AC. .........W. .......... <br /> Disposal FiAd,JSpec1fy.;.Re uIrementis) VIC..................... .......................... ......... <br /> ............ <br /> q <br /> ........... .................. .............................................. ............ .......... ............................ <br /> F <br /> ............................... ................................................. .............................. .......................................................................... ............... <br /> (Drow existing and required addition an reverse side) <br /> I hereby certify that I have prepared this application and that the work will be deia In'accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Reguledlons.of the San Joaquin Laced Healdt,01strid-Morse owner ow. 11con- <br /> jor <br /> , I <br /> sod agents sigitatuve certifies the following: i.- <br /> I certify that In the performance of the work far which this ponnif Is issued, I shall not employ city parson in such manner <br /> at to become subject to Workman's Compensation laws of California." <br /> Signed --------- ......................... .................... ............................ owner <br /> ................. <br /> BY _­._;;:FiE��i;;����� . Title Title <br /> than ownerJ.._.,,_, - _ - -,i 1 -.6. - i_ - <br /> FOR-DEPARTMENT:USE S@k-f <br /> APPLICATION ACCEPTED BY . .......... DATE.. ........... <br /> BUILDING -PERMIT ISSUED ................ ..................... ................................­............ ..DATE ............... ........................... <br /> ADDITIONALCOMMENTS ..... ................ ................................................................................................................................I......... <br /> ...................%...............­----­--------I...........................................................................I.................................... <br /> ........................I------------­ ............................. ...................................................................................... <br /> . .................................................................I.... ......... . . .. ...... ..................................................... ................ <br /> FinalInspection by: ........................... .....;KS�...................... ..............................................Date ............................................ <br /> EH 13 24 1-68 Rev. 51 SAN ioAQuIN LOCAL HEALTH DISTRICT 8/74 3M <br />