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FOR OFFICE USE: �31 <br /> 'im OFFICE USE: <br /> ... ............................. ....... ...... APPLICATION FOR SANITATION PERMIT <br /> ......... .......................................... (Complete In Triplicate) Permit No. .,; <br /> .. .................................................. <br /> This Permit Ex ares 1 Yiar From Date issuedDate IssU*d'.'.s--f.-.7f� <br /> Application is hereby made to the Sum Joaquin Local Health I....... ... <br /> '!iaOThis application <br /> described,lDistrict for a perrmit to construct and install the work herein <br /> JOB *'�11' is made In cam Ranee-m*9 with' Ordinance No. S49 and existing Rules and Regulations, <br /> ADDRESSAOCATION Owner's Name 2 <br /> ,m <br /> .........rli,�ISLIS TRACT ........ <br /> .......... <br /> ...........**......*.............................. <br /> ............... <br /> .......o­.. city <br /> Contractor* .6c. j <br /> ........................ <br /> Installation will ...............................................License # FROY4f.. ph... <br /> serve; Residence rknent Noun 0 Commercial oTraller Court [3 <br /> Number of living units:, MOW 0 Other..........;..........a.....:_.............*............. <br /> Water Supply: .... ..... Number of be�droor4s ­a­.c-wbq99 GrInd&r)F.gA... Lot fie'.....34.1n-%--A <br /> Public System and name .... ............... <br /> Character of soil to a depth of 3 feet: <br /> Sand Silt o Clay [3 <br /> peat❑ C3 Sandy Loom 0 Clay Loom 0 <br /> Hardpan 0 Adobe Q--1`1 rim6terial....044-0 0 Yes, te <br /> type.............. <br /> (Plot Plan, showing size of lot, location Of system' in relation to wells, buildings, etc. must be placed..on reverse side.) <br /> NEW INSTALLATION (No septic tank <br /> or seepage pit permitted If.public sewer I available within 200 feet,)PACKAGE TREATMENT SEPTIC TANK f <br /> Sim................ Liquid Depth .................... <br /> Capacity <br /> ........ ....... Type ................ Material... ............•.... No. <br /> Distance to nearest, Well ;--,-_-•- ; Compartments ....... <br /> . ......:...... Prop. Line....--' <br /> LEACHING LINE No. of Lines ............. <br /> ......................� Length of each line.... ...... <br /> ­1 t......... Tolad Le�gih .......... X <br /> *D' BOX TY06 Filter Material .....................Depth FIIW� Material"._..:..,..:.: <br /> Distance to nearest. Well-... .............. --—---- <br /> --m ............. Fournelation- <br /> SEEPAGE PIT Do 'Property Line ............... <br /> Depth -Diameter ........... M <br /> - I I ­j Nurn6' ...................... Rook Filled Yes 0 Na 0 <br /> Water Table.Depth .' I <br /> - <br /> ........................--...-Rock Size ........... <br /> ............. <br /> Distance to nearest. Well .................. ..Foundation .................... Prop. Line <br /> REPAIR/_ ADDITION lPrev. Sanitation Permit# <br /> ........................... .......... <br /> Septic Tank (Specify Requirements) ......... <br /> '­--- ... ................................. <br /> ISPecify Requirements) .......... ........... <br /> Disposal Field <br /> . .............. ................ ................................. <br /> .......... <br /> jMe....... <br /> - ---- ------------ ------- <br /> ........................................................... <br /> I . <br /> ............. ......... . ...... ......... ........... .......................... <br /> ................ ....................... <br /> I hereby certify that I t I have <br /> (Draw existing and'required addition an reverse side) <br /> prepared this application and that the work will be <br /> County Ordinances, State Laws, and Rules and Regulations done in accar'donce with son Joaquin <br /> sed agents sign tions of the Son Joaquin Local Health District: Ndfflne'owner or licewl <br /> signature certifies the following: <br /> "I certify that in the performance of <br /> the work for which this permit is <br /> as to became subject to Workman's compensation laws of California."issued, I shelf not employ any person in such manner <br /> Signed <br /> By .......--------------------------- Owne;,T) I <br /> ... yitleother than ownerl ........ <br /> ..................... <br /> FOR <br /> APPLICATION ACCEPTED BY. USE ONLY <br /> P. <br /> BUILDING PERMIT ISSUED.. ............ ... ... ....... .............................. DATE <br /> ........... ............... ..............................DATE ...... .......... <br /> ADDITIONAL COMMENTS ......................... .....-.5..-._.... <br /> ............ <br /> .................­­........ ......... ............................... <br /> ............... ............................ I .- '.'I....*............... I........ ....................... <br /> ........................ ................................ <br /> ........... <br /> .................7-.......;- `'•........_......._... <br /> ,)Tial In.S tan Peet <br /> by ..... ................................ ..................... <br /> . .....*.. ....4 IDate . <br /> "o--, ------------**---,-,-,---..........................._..vi-** <br /> �OAG)IJINJOCAL HEALTH DISTRICT <br /> E. H.13 241-'68 Rev. 5M <br />