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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> .... <br /> ............= . Perm <br /> .... It No. ........ <br /> �/_ (Complete In Triplicate) <br /> .......................... . <br /> ............. <br /> .......I............_.............. This Permit Expires I Year from Dow Issued Date Fsstied <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 0 din ce No. 549 and existing Rules and'Regulations- <br /> -1 <br /> JOB ADDRESS/LOCATION ... .......... "ice. CENSUS TRACT ............... <br /> Owner's Name ........ . .......... ........................... Phone ...... ...... <br /> C,Address ...71J. ...... .............._­­-) ...... ty "'UP v;U/;9,_A................... .................... <br /> C�ntrcictor's Name ........Z_,a... .............I.............t_)g. ..................--n-.-license # ----------- ......... Phone". ."O <br /> Installation will serve: Residence KApartment House 0 Commercial OTraller Court 0 <br /> Motel []Other............................................. <br /> Number of living units.--J... ... Number of bedrooms ...Z....Garbage Gri er Lot Size .. .... ......... <br /> .. ......... . <br /> Water Supply. Public System and name ....... ..................... ................. ...­( Z <br /> ............ ..... ......Private <br /> Character of soil too depth of 3 feet- Sand Silto Clayo Peato Sandy Loam [3 Clay Loam' M, : <br /> Hardpan 0 Adobe E2FIII 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 /> PACKAGE TREATMENT SEPTIC TANKK . . j.. <br /> .... <br /> ij Capacity ---- Type No. Compartments ....... ...... <br /> Distance to nearest: Well ....N.X-.VL�_ .............Founclaflon!�'-_/.-.P_t.,'r"...... Prop. Line <br /> . <br /> LEACHING LINE Noo# Lines .....41� <br /> E ines -----t--------_-------- Length -f each I.ne c? Id-..-_....____.. Total Length d-44 ............. <br /> 'D' Box ............ Type Filter Material T- t -Depth Filter Material ---- ............... . .. <br /> Distance to ne%r <br /> -est. Well ...... Found <br /> tion J...0.............. Property Line ... ...6.......... .. <br /> A <br /> SEEPAGE PIT Depth .._41-A_.._..._41-A_.._. Diameter Number _...._._....I......:....... Rock Filled Yes Q 1 Na 113 <br /> Water Tobl V2 0 1 <br /> a Depth ..... ....... ..._Rock Size ... .. --- <br /> Distance to nearest. Well ......... ............................Foundation Prop. Line ...... ............... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..Z ..............._...................... Dote ... <br /> Septic Tank (Specify Requirements) ------------- --- I----------------­­- .................................................. <br /> bisposal Field (Specify Requirements) --- -- I_= ....... <br /> ......................... <br /> ------------ -------- <br /> ------------- ---------------------------- -------- .. ......... ­_:­­---------------:-----­-------------I <br /> •------------------------------------------------------- - -- - --------- ---------------------------------•---•------•----------- ............. -------------­-- .................... <br /> (Draw exist!'ng and required addition on reverse side) <br /> I hireby 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 San Joaquin Local Health,District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that In the erFormonce of-the work for"which this permit <br /> Is tkwed,-1-shall not employ any person in such manner <br /> e ror <br /> s <br /> e �'j Mal <br /> as to bec ec t Workman's CCo Workman's I s of California." <br /> Signed ------- ---------------­--------- ---------- . .... ........ ............. <br /> By ------------- ------------------------------------------------------- ---------------- litle -------------------------- <br /> --- ...... --------- ...... <br /> ij (If other than owner) <br /> �R DEPARTMENT USE ONLY <br /> APhICATION ACCEPTED BY ....r ----- - ----------------------------------------------------------------------------r­­------ DATE <br /> U B <br /> BUILDING PERMIT ISSUED ..... .. ...... ------- ..............1 <br /> T ------ <br /> ADQIT�INA�Lj MMENT --- ---------- A4 --- ------ ------ . ...... <br /> r <br /> V <br /> - -------- ------ <br /> ----­----------------------- ----------- -------- .... ...... .. ...E TM. --- .......... .// ............................... <br /> ----------------------------------- _...--._._..._...-----------•-.._...--- ............ ......... ................................ ...........­................................. . <br /> FinalInspection by: ------------_- --------------------------------------- ................ ---:------.....---........-........Date .......................... ..... ......... <br /> Eflt.13 2h 1-68 lik-.v. 5M SAN JOAQUIN -LOCAL HEALTH DISTRICT 8/7h 3M <br />