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I <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . <br /> I--........ � (Complete in Triplica#el <br /> .............• . �1 Date issued ..L�::r�---5�•7 <br /> .:................. ........._..-..... <br /> IN This Permit Expires 1 Year From D #e Issued <br /> l the work <br /> is hereby made to the San Joaquin Local Health District toan a permit <br /> to cons <br /> and existing Rulestruct and alnd Regulations- <br /> S' <br /> egulgt onsrein <br /> ApplicationY )lance with County O <br /> described. This application is: made m comp L� u <br /> � - f CENSUS TRACT <br /> JOB ADDRE55/LOCATI6N M.6. <br /> -_� •�-�.��`1.�.4�.Y o10 PP.__.4...,�.�°.��:..--•-•.............. ane . <br /> Owner's 'Nome .-.... �� '• <br /> I� ......__. City _.. `{'�`�!�..- r <br /> Address .-.-..... ` ...... .... <br /> -..-------- S 3 Phone . <br /> i ��i" ,�}il _- oN S� G..._.License # .` ... <br /> Contractor's Name ._.-.•--•--•--=- ,. • � <br /> Installation will serve: Residence ❑ Apartment House'❑ Commercial,]Traller Court a <br /> I Motel [3 Other ----.� � <br /> '. Garbage Lot Size .Iz.�?'���-z'o�................. <br /> i Number of living units:.---..I�.__-- Number of ---•••• g 1 M.Private ❑ <br /> Public 5 stern and name .----• ----- ------- -•-- -•---......-.. ..�..----------- ••------•- - la <br /> Wafter Supply: Y i Clay Loam <br /> Peat Sandy Loam Y ii. <br /> Character of soil to a depth lof 3 feet: Sand'❑ Silt❑ Clay ❑ ❑ <br /> } 11Hardpgn C] Adobe C] Fill Material .......a..-. if yes,type _....-- <br /> I --------.�, <br /> 1 t Ian showing size of lot, location of system in relation to wells,"buildings, etc. must on reverse side.} <br /> (Po P IIII i , ti . I i <br /> NEWINSTALLATION: (NJ. septic tank oriseepage pit perrr►itted if public.sewer is available within 200 feet,) 1r r r <br /> Liquid Depth _.-.��_.�_..?:_...:.. <br /> SEPTIC TANK Size__ ....�a• --••••- , <br /> PACKAGE TREATMENT ( ]' d "M <br /> No. Compartments _.._.•-r--•••-•-...-- <br /> p �' Material__. , p <br /> I Capacity ( Type 1 R '..y.._.... fi <br /> S _�...__...:.. <br /> u1, '` �` ...............Foundation .. Prop:I�Lin,a - <br /> I pistance to nearest: Well _._ C <br /> -• r <br /> 'ISI Length of each line--------[;�4..........: Total -LengtliM ...1* 4........••-•••---• <br /> � � No. of Lines ..----- , <br /> LEACHING LINE t '- <br /> ill ,D'W R De th. Filter Material ••---•-••••-......•• -' <br /> 'D" Box "_(—.---Type Filter Material •--•-• P _-__.--••---- <br /> 4 �� Property Line <br /> . Foundation --:.rte.............. P nY <br /> I i Distance to nearest: Welly .--..-••-• No Q <br /> Rock Filled, Yes 0 <br /> De th E w~Diameter---:=—..... Number-,7 ------------------ <br /> SEEPAGE^ PIT ( 1 �iP <br /> .rte" -- <br /> i <br /> - Rock Size .........................--..... <br /> Water Table Dep..................••---•---......._.... e <br /> :. I Foundation op.' m <br /> I Distance to nearest: Well -------_.-•................. <br /> REPAIR/ADDITION(Prev. S'nitation Permit!#._.................................._...._. <br /> `Date ..............4...... <br /> :. ..:.._.) <br /> Septic Tank (Specify Requirements) .................:. <br /> ....................... ..... II <br /> :I -----•----- •-•--•--....___..••... ••-•---•-•.-..-_. ---•--- •---•---•-• -------------------•--- •-••-..._.••••-......--._...... <br /> Disposal Field (Speci4 Requirements) ------------- ...................... • { <br /> ..... . ..... <br /> �' . I�., <br /> (Draw existing and required addition on reverse side) <br /> rclace ,wh Son Joaquin <br /> I hereby certify that I hove prepared this application and that the war ioHealth Dist ctnHemetowner or Ilicen- <br /> County Ordinances, StatJlLows, and Rules and Regulations of the San Joaquin Lnca ; <br /> sed agents signature certifies the following: ploy any person in such manner <br /> "I certify that in the performance of the work for which this permit is issued, I shall not emh <br /> as to become subject to Wo man's Compensation laws of California:" �p <br /> Signed <br /> I� ------------------ Owner S <br /> Title ` <br /> (if other than owner) I� <br /> I` FOR DEPARTMENT USE ONLY <br /> I �` s <br /> ' ...........:.................... DATE ? ..Y 7 .................. <br /> APPLICATION ACCEPTED BY ... . <br /> ------.-•...... ...............DATE'...._....�s: <br /> BUILDING, PERMIT ISSUED <br /> ••--- = <br /> i ADDITIONAL COMMENTS ..............••--••---......................... <br /> .__......---•-•------..._-- <br /> ...........................i-•-•- <br /> :_.... . .......... <br /> ;.. <br /> - <br /> .., <br /> &x6CU Date <br /> Final Ins ection b .t - .................................................. <br /> ' SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I� 7/723 ,4 G <br />