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FOR OFFICE USE: Y APPLICATION FOR SANITATION PERMIT <br /> ---------- -------------------------------------- Complete in Triplicate) Permit No.. <br /> .........15�2. --------- -- -4. ate Issued Date Issued <br /> This Permit Expires I Year From D <br /> %14---------------------- ---W.-I . _ r r, <br /> a construct and--' ;tdll,the work herein <br /> Application is hereby made to the San -al-pe-r-m-it-t -_ - ins <br /> fall <br /> This application is made in/c mpliance with County Ordinance No. 549 and existing -Rules and Regulations- <br /> VCENSUS TRACT -------------- ----------- <br /> --------- <br /> JOB ADDRESS/LOCATION --- <br /> Owner's Name --- ------------------------------------------------ -------Phone ------------------------------------ <br /> C­7� /_ e�/_�/_ <br /> Address ---- 1 --- --- --- ------ - ------- ----------------------- <br /> ----------------- , Z <br /> ;? <br /> �_ - <br /> -------- <br /> / - --- <br /> --- ------------- Cit - ---- ---------------------- ------ <br /> lei <br /> XO / License * Px� -- Phone �� <br /> Contractor's Name _ / - '� <br /> Installation will serve. Residence I X Apartment Housef-1 Commercial [-]Trail6r Court 0 <br /> Mtel F-1 Other -------------------------------------------- <br /> Ie' ...... <br /> - ---- Lot Size 111-ax_/1'r <br /> Number of living units:_-- ---- Number of bedrooms --- <br /> Garbo e Grin er - <br /> --------Private F-1 <br /> Water Supply: Public System and <br /> I Clay peat Q Sandy Loam -[I Clay Loam E] <br /> Charatter of soil to a depth of 3 feet Sand'E] Silt El <br /> feet: Sand <br /> i'-Adobe Fill MaterGl,­!---------- If yes,type -------i-------- ------- <br /> M -elation to wells, buildings, etc., must be placed on reverse side.] <br /> ]Plot plan, showing size of lot, lodtion of system in r <br /> T page pit permitted if public sewer is available within 200 feet,) <br /> NEW INSTALLATION: (No septic 4afnk."or see <br /> Size-- __/---------- Liquid Depth ----------- <br /> PACKAGE TREATMENT SEPT11,C,TA__NK <br /> X I No. Compartments 9----------------- <br /> ---- Type Material- <br /> Cappcit'/ Typew <br /> Foundation ------------- PropJine _11;�_W__---------- <br /> Distance to nearest. Wel 7 <br /> . ............... <br /> -------- ------ Total Length _e, <br /> LEACHING LINE No. of L'ines ------------ Length of each lin 67V- I'll/ <br /> g d w;7 <br /> M te <br /> 'D' Box Type Filter Material//,�/4a-;,'_'D;pth Filter material <br /> Distance to 'nearest: Well __ -1----------:__ Foundation ---;2e------------- ,Property Line. --------- <br /> A/ <br /> I No 0 <br /> SEEPAGE PIT Depth X--------- Diameter -------- Number,--m---;?------------------- Rock Filled Ye <br /> Rock Size /11/7fn-L.�F/11---------I- <br /> Water Table' Depth ----do;�---- -- - 0 / <br /> Distance to nearest; Well -------777777=--------------------FoU6dcttion --p-2------------ Prop. Line ------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date ----------------------------------) <br /> Septic Tank (Specify Requirements) ------------------------ -------------------------------------------------------------------- ------------- <br /> -------------------------------- <br /> Disposal Field (Specify Requirements) ----------------------------------------------------------------------------------- <br /> ---- -------------- <br /> - <br /> ------- --------- ---------------------------------------------------------------------------------- ------------------------------- ------------------ <br /> ---- ------------- ------------------------ ------------------------------------- <br /> ------------------------------------------------------------ <br /> ------------------------------------------------------------------------------------------------ <br /> (Draw existing and required addition on reverse side <br /> I hereby certify that I have pr pared this application and that the work will he donei en accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations <br /> of_the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: issued, I shall not employ any person in such manner <br /> "I certify that in the performance of the work for which this permit is <br /> as to become subject to W*rkman's Compensation laws of California." <br /> Signed ( <br /> Own <br /> er <br /> - Title <br /> -Ifo er than owner] <br /> -- <br /> By - --------- - - ------------------------ <br /> FOR DEPARTMENT USE ONLY <br /> al <br /> APPLICATION ACCEPTED BY ------------------- DATE ----- .---/--------------------------- <br /> - ------------------ ------------------------ <br /> 7: --------- ---DATE ----------------- -------------- <br /> BUILDINGPERMIT ISSUED -------- ----------------------------------------;.K_1-------------------------------------------------- <br /> - -------------------- ------------ ---------------------- --- <br /> ADDITIONALCOMMENTS -------------------------------------------------�­------------ ----------------------------------------------- <br /> --------------- ----------------(--- -----------------------------------4-------------------------------------------------------- --- ------ <br /> ----------------- -------------------------------- ---------- <br /> ------------------------ ------------------------- ------------------------ --- <br /> ---------- <br /> --- ------------ -- ( <br /> ------------ _Z------- <br /> 1-4---- ------- -- ------- -- <br /> _2 <br /> ------------------------------------------- <br /> �__: ---------- ----------------- ------------------------------------------------------ <br /> ---------- - <br /> ------------------- <br /> - -------------- ------------- Date -6zw--- ---- ------- -- -------- <br /> Final Inspection by: --- ----------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />