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FOR OFFICE USE: <br /> APPLICATION"'FOR SANITATION PERMIT <br /> ................... <br /> Permit No; .. ..'7, <br /> ............. <br /> (Completein Triplicate) <br /> ....................I......................... . <br /> ....................................... <br /> This Permit Expires I Year From Date Issued Date Issued .3-ILCYT <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 Nome ....... _....---------•Phone _1r7Z1.?_?J........... <br /> Address ..................... -------a.;( P ........ ..... .......... city ........ ...................................................... <br /> Contractor's Nome ..................... ....... <br /> ...................License #; - .(_.3........ Phone ............................ <br /> Installation will serve. Residence C]Apartment Housso Commercial OTraller Court 0 <br /> V, Motel 0 Other .................................. <br /> tNumber of living unitst......C.—Number of bedrooms _5.....Garbage Grinder ....:....... Lot Size .......... ................ <br /> ,�dter Supply: Public System and name ........................V,��.........................................................._....................Private <br /> Charecterof-soll-too-dept df,3r 2ei. Sand C]; _SlItL 61ay 0" Peat.[] - -so'nc(y Loom 0--Clay <br /> Hardpan E] AdOWIX fill Material ............ If yes,type ............................ <br /> (Plot plan, showing size of lot, location of system In relation to' wells, buildings, etc. most be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank,or seepage pit permitted 'if public sewer ls voilable within 200 feet) <br /> PACKAGE TREATMENT <br /> SEPTIC RANK -Size. K <br /> . .... ...... Liquid Depth ............ <br /> Capacityl?'W. ...... Ty a ...................... N a. Compartments ._...Z-........._ <br /> '- <br /> Prop. Line ....5. ........ <br /> Distance to nearest: 11 .... . ......... ation <br /> IV <br /> IQ - so +' <br /> 1E ING.LINE—K—No-;-6Vttn1' a e. <br /> ...... .Length of eA...YR I.......... .Total Length ............................ <br /> V Z <br /> ....... Y _hIt' Material .......... . ......Depth Filter Material <br /> D' Box I PPW <br /> �y <br /> .......... <br /> Distance to nearest- <br /> ANWT`4Z.; .. Foundation ! Property Line <br /> ............ ........................ <br /> "i�esl�&_' No <br /> Kd.`c'k,'FiI led <br /> EEPAG I Depth,,Att�.!s------ Diameter ...... :o?L�.... iD <br /> Water Table Depth <br /> ................. <br /> Rock`S1za 1 <br /> -T 3 <br /> Distancenearest: Well <br /> ...................... . ......Foundation ............. ....Y Prop. Line ..-.,6 ............ <br /> REP TION Wrew-SanitationoPermit 1Date ...... 7 ......I <br /> Z! <br /> Septic Tank (Specify Requireriients) .......... <br /> ..... ...... <br /> Disposal Field JSpecl Requireilnents),_.4 ......&111 <br /> 77 T�, <br /> .......... . . ........................... <br /> �.. -rye- "n� r� _ `""'' <br /> ®ro existing d re ired*6cIdItion,on reverse side) <br /> tit It <br /> I r, y c -tiVylthat I have prepared this application and that the work will4e, done InAccordance with-Son Joaquin <br /> County 0 1 Inaric-es, State Laws, and Rules and Regulations of the Son Joaqdin Local-Health.District. Ham* owner or licen- <br /> sed ag certifies the following:/ <br /> Ovork'for which this p ssued, I shall not amp[ <br /> 1 certify that in the performance of the .1e . I <br /> ermItAs-I o��"',-Ibin�y person In such manner <br /> as to become subject to Workman's Compensation laws of allf�rnia.­ <br /> ' ­ . / /I-�c <br /> Signed ----------------•-._...._.------- ---------- ­- -----.. . ........ ....................... Owner <br /> By ....... ........... .. . ......... <br /> P(�Z- -- --------/... Title .... ........... <br /> f otherthh h owner---- ---------- ....... . ------- ..... ... <br /> FO(R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> ...... ........ ........... .....................DATE <br /> ..... <br /> BUILDING PERMIT ISSUED . ------------------------------------ -------------------------------------DATE ...........----.........................L. <br /> ADDITIQAL COMMENTS ................. ........ ...... .................. . ...... ........ ....... ............ <br /> . ..... . .. .........al�p--�_ ------- .. . . ..... .................... ........... <br /> . ............................... <br /> ................. ....... ------­--------- <br /> ...... ...... ate <br /> ... ..... ... <br /> Final inspection by: ..... . .. <br /> 7-1.........*.......­_­.. ............ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F_t4.13 241_-Aan__ =AA- <br />