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FOR OFFICE USE. 3w rs� <br /> APPLICATION FOR SANITATION PERMIT <br /> .............. ...................... Permit No; -V..Y53..... <br /> (Complete in Triplicate) <br /> _._______..•__________________•__.__________.....___. This Permit Expires I Year From Date Issued <br /> Dote 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 Aunty Ordin No. 549 and existing Rules and Regulations. <br /> y Ord <br /> 2=115 V4 <br /> OC Ap/, <br /> a.....................CENSUS TR <br /> JOB ADDR/SS4/?LVATION A ......... ACT ....S-1.7......----- <br /> Owner's <br /> ......Owner's Norma ---LO.-M. A----- .......A-ai-o-r-t-r-j.................. .............Phone—......... ....................... <br /> Address .............City —5to.eAlarl....... .................................... <br /> C..... K..........License Phone ..... <br /> Contractor's Name ....... -TOA) <br /> Installation will serve: Residence Apartment House C] Commercial OTraller Court Cl <br /> I Motel 0 Other-------------------------------------------- <br /> Number of living units:_..Xq Number of bedrooms .....Garba.ge Grinderna.. Lot size ....h9a..azrs�i------------ <br /> Water Supply: Public System and name ................... ..............................__................................. ..............Private <br /> Character of soil too depth of 3 feet; Sand'[] Silto Clay [] Peat E] Sandy Loom-Fj Clay Loom <br /> Hardpan X Adobe'[:] Fill Material ...... ..... If yes,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 or seepage pit permitted if public sewer is available within 200 feet,) <br /> Liquid Depth ....AVR. <br /> ...... <br /> PACKAGE TREATMENT SEPTIC TANK Size........��,e.$-//!!� - <br /> Capacity'-/.:W. ... ITypeS.:c_____________ Material Nrt <br /> o. Compartments .__It__...___..:.... <br /> 99L <br /> Distance Ito nearest: Well .................Founciation':7.14---/-..... Prop. Line .......... <br /> LEACHING LINE No. of Lines .... Length of each Total Length .... <br /> K :------- Ae <br /> 'D' Box V..... Type Filter Material ..........Depth Filter Material ......./1?............................. <br /> Distanceito nearest. Well __.ZDV____-------- Foundation -------- Property Line. ___10 -............. <br /> elf <br /> SEEPAGE PIT lei`,, Depth ... ... Diameter ...1313_.___. <br /> Number ........ .......... Rock Filled Yes ff" No 0 <br /> Water Table Depth -----•----- ..........................Rock Size ..•-•-,X--OV------------------ <br /> Distance to nearest; ___________________Foundation ........ Prop. Line ... ....... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..........................................._ Date .................................. <br /> Septic Tank (Specify Requirements) .................. ....a------ --- •--------•-----••---------•----•••-••--•----• •-•-••............. <br /> t ;1!�i - - I <br /> Disposal Field. (Specify Requirements} .......................... <br /> r --------------- .................... .................................................. <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 done in accordance with Son Joaquin <br /> County Ordinances, State Laws,'and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to becomes lett to Workmay, <br /> Compensation laws of California." <br /> Signed ...... ................. Owner <br /> BY........................................I------- ................................................. Title -----4:Z1W- --------------- ------------------------ <br /> (If other than owner} <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY.. .... . .. . ....... ... ............. ............................................I...... DATE ----------------- <br /> BUILDINGPERMIT -----------------------------------------------------------------------------------------------DATE ........-..................... ----------- <br /> ADDITIONALCOMMENTS ............................ ..................I.............-........................................................__................................ <br /> .............. ...............................................................--.............................. ............................................................................. <br /> ....................................... -------------------------------------------------------------11.............----------- -------------- ------- <br /> ..........................i� ............ ... ....... <br /> Final Inspection .......................... -•--...-•-•-------••.---•--••--•-•-- ............Date <br /> ----------------- <br /> ------------- ---------------------------- ------------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />