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FOR OFFICE USE: <br /> APPLICATION- FORIANITATION PERMIT Permit No.. <br /> --------- ------------------- ------- Complete in Triplicate) <br /> ------- --------------------------- <br /> ----------------------- <br /> Date Issued ------_.- --_. <br /> r ______ This <br /> ----- ------------- <br /> This Permit Expires 1 Year From Date Issued <br /> --------------------------7--------------- <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-a..nd Regulations: <br /> :ATI'ON --------- L-------R-D----------------------CENSUS TRACT ------- <br /> JOB ADDRESS/LOC <br /> 'V _X --- --u <br /> --- JAJ V_7—-------- tvrl�_�7=;X----------------------------------------Phone ---------------------*-------------- <br /> Owner's Name ---- CIF I <br /> -V F cit ------A5�S_CAJ-:Dw------- -- ------------------------- <br /> Address ------30-3-o--, %ety <br /> Contractor's Name OW_N�!: ------------------------------------- -------------- -----------License,# ------- ----------------- Phone <br /> Installation will1erve.. Resi,dencep<_a rtmen-t HouseE] Comni,ercial :DTrailler Court 0 <br /> Motel M Other --------------------------- --------------- <br /> i. Number of living units:_.-- Number of bedrooms 3-------Garba�ge"Gri nde/r)/4fF,5 Lot Size -------- <br /> Water <br /> - -------------------------- <br /> Water Supply- Pu-bl ic System and name ------------------------------------------------------------ ------:Private <br /> P -E]—Cl ay-Loa rn <br /> —C I a y�E] .Peat EL oi Loam <br /> Character of soil to dde depth of 3 feet:_T San'cl,.�k�m_t__o ,.Saindy- <br /> Hardpan E] Adobe,:E] Fill Material __/V9_ if yes,ty'p'e.,,---------------------------- <br /> (Plot plan, showing size of lot, location of_ system n relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seep e pit permitted if public sewer is available within 200 feet,) <br /> - -- ------- <br /> PACKAGE TREATMENT SEPTIC TANK f, Size--,// --------- Liquid. Depth --- /_�_/ --- <br /> Capacity /10e ------------------ <br /> Type RE-091—materia' l fko�k_ No. 'Compartments <br /> istance to nearest.. Well .......56--------------------..Founclation ---- ----------- Prop. Line ----5-------------- <br /> 7 <br /> 0 <br /> N( ------- Total Length ----- -- ---------- ...... <br /> LEACHING LINE 0. of Lines ------------- Length of each ,fine------ -------- <br /> - <br /> 'D' Bo 5- Type Filter Material ---Depth Filter Material -----/4/--------------------------------- <br /> -'-%C--------!---- ,`l <br /> r'l ..-5----------------1 <br /> --Distance4o-nearest:.-Well...�,4>—O"'-----�-�-.,Foundat.lon-.- ' Prop�rty Line <br /> ' <br /> SEEPAGE PIT C j Depth -------------------- Diameter ---------------- Number --- -------------------2- Rock Filled Yes F] No CC] <br /> Water Table Depth _ - <br /> -C- <br /> ------_---RockSize -------- ----- -------:n- <br /> ----------------- � _, P-6p.-Llne�-------- -nI--- -- <br /> Distance to nearest:Qell __ - ---- -- ------------------------Founc6ion,,-__ <br /> --- Date -REPAIR/APDITION(Prev. Sanitation Permit# ------------------ ----------- ---- ------ <br /> -------------- -----------------------------------­-- <br /> zz <br /> Se ic Tank (Specify Requirements) ........:----- ----------------------- -------- <br /> Disposai.-Yie!1d (Specify Requirements) ---------------------------- ------ ----------------------------------------------------------- ------------------------- ----------- <br /> ---------------------------- -------------------------- -------------------- ----------------------------------------------------------------------------/-------------------------I----------------i-------- <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 ilorie in accordance with Son Joaquin <br /> 10 <br /> d Rules and Regulations of the Son J Home owner or licen- <br /> sed agent signatilre certifies the following: _" 1 411. ;1 <br /> i any person in such manner <br /> "I 4:e,!t _at in the perforynance of he workpir which this permit is issued, I shall employ a <br /> omp r;aws <br /> 'to 0 California." <br /> subject rkman omp laws o C <br /> as to b%cme sub <br /> ........... <br /> Owner <br /> ...... ... ---- ---- <br /> Signed <br /> ---------------77 <br /> ------ ---------- ------------------------- ---------- ------------------------ <br /> By ------------------------ --- -------------------------------- --------- -- Title <br /> (If other than owner)r <br /> FOR DEPARTMENT USI; ONLY <br /> APPLICATION ACCEPTED BY ---------TTS_R_-O------------------------------------------------------------------- DATE ----- --- 1 --------- ----Z----. <br /> ----_-DATE ----------------------- <br /> ------- ------------ <br /> BUILDING_PERMIT_ISSU.ED-------------- - ------------------- <br /> ADDITIONALCOMMENTS - - --------------------------------- - --- ------------------- ------------------------------- -------------------------- <br /> !n- --------L_ ........�� ------ -------------------------------------------------------------------- <br /> ----------------------------------- — - . . " -­;:- —-,-# <br /> -- ------------------ <br /> --C------------ - ------ ------ --------------------------- ----------------- /----------------------------------------------------- <br /> ------------------------------------ --------- --- <br /> --------S:7 <br /> Date --- ------ --------- <br /> ------------ ---------------- --- <br /> FinalInspectio - ------------- - - --------- ----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />