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APPLICATION FOR SANITATION PERMITPcIrmit No. I. <br /> r ! <br /> (Complete in Triplicate) <br /> Date Issued <br /> This Permit Expi•es 1 Year From Date Issued <br /> Aoplicat;on is herc-bv mode to '1," 5­1 17nnu;r. Local Health DiOl lc' for n permit •O construct and Install the work herein <br /> described. This application is r'ado .n :cmpliancc. with Count, orri;nance No 540 and Px;s!ing Rues and Regulations: <br /> �) CENSUS TRACT . <br /> J^B ADDRESS'LOCA fIC l ••'� -- �- - <br /> t <br /> Phone <br /> Owner's Name <br /> - - <br /> Address :? c '-�- �t� // _ / City <br /> Com:actor s Nam^ <br /> License #� �jcf ` Phone <br /> Installati;+n will serve: Residence Apartment House Commercial (?Trailer Court C <br /> Motr,l F-1 Other ^M-..-k-a.Ia•, <br /> Number of living units: Numl-rrr of bedrooms Gorbage Gr-nder Lot Sze <br /> Private <br /> Water Supply: Public System and n-rmc <br /> Character of soil to a depth of 3 feet: Sand [] Silt❑ Clay Peat[' Sandy loam Clay Loam f 1 <br /> Hardpan ""' Adobe f-1 Fill Material if yes,type <br /> Mot plan, %hawing size of lot, locrt'on of system in relation to wells, buildings• etc. must be placed on reverse side.) <br /> NEW INSTALLATION: No septic took cr seep a pit permitted if public sewers available within 200 feet,l� <br /> ,rr F E 1 SEPTIC TANK[F 5ize. �X liquid Depth <br /> ,._ �,�_ TREATMENT i <br /> CODacity 1 5 C C,( TyPe�rC MateriA._4 k.C-4-a-� No. Compartments t <br /> ( Foundation ITP a Prop. line S <br /> -�:Distance to nearest: Well �CC' _ 9 I S o <br /> 7 Length of each line 7 S Length LEACHING LIN [ � No of Lincs Total Len 9 r• <br /> 'D' Box Type Filter Material .S .�I_ Depth Filter Material 1I .r . -•. <br /> � Distance nearest: Well <br /> d t.^ ( Foundation C t Property Line 4 .. •••••. <br /> Diameter SEEPAGE PIT Depth <br /> 2 S r �' Numbe- Rock Filled Yes [J�No <br /> ❑ <br /> (� p f�, ..�.�� •• <br /> Water Tab!c Depth C C Rock Size , <br /> r5 <br /> Distance to nearest: Well 150 ..Foundation I C Prep. Line <br /> REPAIR/ADDITION(Prev. Sanitation Permit# <br /> Date ) � <br /> Septic Tank (Specify Renuirements) <br /> Disposal Field (Specify Requirements) <br /> ;Draw ex,stinq and required addition on reverse side) <br /> e done in occO <br /> I hereby rdimances Sthave <br /> a Law%pond Rulesthis andcation and that the work will Regulalions of the Son Joaquin local Health D itr tt. with <br /> r oraaligcenn <br /> County Ord n <br /> sed agents signature certifies the following: Arson in such manner <br /> "I certify that in the performance of the work for which This permit is issued, I shall not employ any p <br /> as :o become subject to Workman's Comp sation laws of California." — <br /> Owner <br /> Signed <br /> By. <br /> Il; ether than o A n•r' <br /> FOR DEPARTM°NT I1:E ONLY C <br /> �" :•:-f+ a-r c C %OL DATE s <br /> ArPLICATION ACCEPTED BY DATE <br /> B'JILD't:G PERMIT ISSUED <br /> ADDITIONAL COMMENTS <br /> •t I !r.;,-;U , 7c,-V, HEALTH DISTRICT <br />