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---]FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Il:omplete in Triplicate) Permit No. 74.. . .�. <br /> �. .... <br /> ................. <br /> _.. ...... D 1 ued r <br /> This Permit Expires y Year Erom Date Issued ats ��•- ••�� ..�`:: <br /> Application Is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein <br /> described. This application is made lo compliance with County Ordinance No. 549 and existing Rules and Regutatlonss <br /> JOB ADDRESS/LOCATION .... _...�'... ...............................CENSUS TRACT .......................... <br /> Owner's Name .... .Ry...... t? .M .................................... ... ............. ...........Phone 3� .:�.. .E�O ..... <br /> Address ...UTa � ��M��i.�?NU.--r��� ..............................City .....��?►�.f................... ........................... <br /> Contractor's Name_ .............:...................License ...... Phone <br /> Installation will serves Residence ta Apartment House❑ Commercial❑Traller Court ❑ <br /> Motel []Other............................................ <br /> i?...._Garbage Grinder .........._..Lot Size, ...1ie:tiQ��.X...��. <br /> Number o¢ living units:____`.._____ Number o$ bedrooms.__. � <br /> Water Su 1 : Public S stem and name -- ... -____.Private . <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy loam ❑ day loam 4.-4 - <br /> t Hardpan IR Adobe❑ fill Material yet,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 INSTALLATIONe {No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK 04 Size..................................•----,....... liquid Depth _..............._._._..... <br /> Capacity .�.z -----• TYlaa 1� Grksr. Materlal_�1� '+�. Tt�` No. Compartments --•-Z............. <br /> Distance to nearest: Well 5.0....... Foun10! <br /> ion Prop. Line F <br /> LEACHING LINE V] No. of lines ..........t.......... Length of each line......... .......... Total Length .A.9.0............ <br /> 'D' Sox ......t-._.._ Type Filter Material r'C.`...... .Depth Fliter .Material ......�. ?..'1 .�...................... Q j <br /> : : <br /> .--•-- --•-- ..... Foundation .... ...... ........... Property line•:................. .. <br /> do Distance to nearest: Well <br /> SEEPAGE PIT cj Depth -___25.. .. Diameter ...... Number ............................ Rock Filled Yes No <br /> `70 >X ................... <br /> Water Table Depth --------• ...------•........................Rack Size :..... t <br /> Distance tonearest: Well .....vo., <br /> ........................Foundation .................... Prop..line ..................... <br /> . t <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ._.......---•---•........................... Date ....----............. ............} <br /> Septic Tank (Specify Requirements) ........................••-••---........ ... .........----....... ....._................. <br /> Disposal Field (Specify Requirements) ............................................. ........................................................... -----.................... k <br /> .......•.......................... ......•------........................-•--•------..._.............. ...................................................... <br /> •- . ........._:..... - .:..... <br /> . �..........`.. ...... "----••........... ......... ��......... o� <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the, work will be dons In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or Ilcen- <br /> sed agents signature certifies the following: j <br /> "I certify that in the performance of the worts for which this permit is issued, I shall not employ,any person In such mainnar <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ...................... �—. ..............................I.---......._.... Owner <br /> sy ..: � .. ... • �. ...:........ . . . <br /> �". itte . .. .. <br /> other than owner) <br /> E FOR DEPARTMENT USE ONLY <br /> APPLICATION.,ACCEPTED BY................... . ..................................................................,.......I......DA,T,E.......;y • :... . <br /> BUILDING PERMIT ISSUED .. ....... ....... ----- .... <br /> -., .... DATE <br /> ADDITIONAf COMMENTS .......f ._..... - <br /> ...........................................................................--................-----......-..-----•------ --------- .....---.....---.............. . .......v........................... <br /> ......................................... ......-.--. <br /> Ina Inspection by: ................. <br /> .... .•-'-------�....-----•-----------....-_...................................................... Date ....�. ...�. <br /> EH 13 2h 1-68 Rev. 5n SAN JOAQUIN LOCAL HEALTH DISTRICT �h 3M <br />