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FOR i6FFIC_E USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ------------------------------------------------------- <br /> (Complete in Triplicate) <br /> �2­------:------------------- <br /> --------=---------- -­­ Date issued <br /> This Permit Expires 1 Year From Date Issued <br /> --------------------------I---- ---------I---------------- <br /> Application is hereby made to the San Joaquin Local Health District for a per'mit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> V VTH--------CENSUS TRACT <br /> E - _0 --- <br /> JOB ADDRESS/LO ATION .___/_?T77-----Z -----(f4JI\f-1 ---- ----- - - <br /> -------------------Phone <br /> -..--:---- <br /> Owner's Name 1AUES--------iVANDe-K------- ----------------- <br /> Addres '170 <br /> Address f4--------f!!�OAOIT Cit <br /> y <br /> %14 <br /> Contractor's Name ------- --------------------------------------------- Phone ------------------------------ <br /> ---------License # -------------------- <br /> ' <br /> Installation will serve: .6er idence pT'Xportment House-E] Commercial.:[]Trailer Court 'El <br /> Motel F-1 Other --------------------------------------- <br /> Number of living units------ ---- Number of bedrooms -----Garbage Grincle"r\j��_ _. Lot Size <br /> Water Supply-, Public System and name ---------------------------------------------------------------------- ---------------------------------------- <br /> Private <br /> Character of soil to a-depth of 3 feet:.-_Sand'[D., Silt-F]— Clay _.Ej- -Reat-0. -Sandy Loom_E]_ClayrLoam_Q+_ <br /> Hardpan F] . Ado e F1--Fill Material,.------- --- If yes, type ----------------------------- <br /> s, buildings, etc. ust be placed on reverse side.). <br /> (Plot plan, showing size of lot, location a system iri ,relhti6ni'to well <br /> NEW INSTALLATION: {No septic: tank' or seepage pit permitted if public sewer is 6vaila le within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK Size----------­------ ---------------- -------- --- Liquid Depth -------------------------- <br /> )acity 11o. Compartments ------_------_------ <br /> COF ----------- ---- ---- Typei�;k�----------------. Material---------------------t V I I - ------- <br /> Distance to neare t. 11 --------------Q i-------Foundation -------------- Prop. Line -------------- <br /> th __..____•--------- <br /> -- ---------� ----/---------------- -; otal Length'.LEACHIN61ofeach!Jjne---- <br /> INE No, of Lines -------- --------------- Length _: / I <br /> a. <br /> 'D' Box ------------ Ty oe Filter Material -------------%----?Depth Filter Mc terial -------------- -----•---}--------•---------- <br /> f -- Pro er Lihe ---- ------- <br /> Distance <br /> -------- ------------------ <br /> Distance to neares Well ----------------- --- --- Property Lihe ----------------- ------ <br /> ------- Foundation ---------------- Rock Filled Yes b No 0 <br /> ----------------- --- <br /> IF <br /> .SEEPAGE PIT Depth ------------------- Diameter ---------------- Nvrhbers <br /> Water Table Dept -----.Rock Si e ---- <br /> bi <br /> 91 IlLi ne <br /> Distance to neare Well -------------------------------- ------Found 6ti"o—N,, Prop. --------------- <br /> t Date <br /> REPAIR/ADDITION(Prev. Scinitafl( -------t_ <br /> Det <br /> , .. 1'__.Wt�I [--------- ------------ <br /> Septic Tank (Specify Requirements) ------ ------------------------------------------------------ ----------------- ------- = <br /> 4 1V <br /> 1�- ----------- <br /> Disposal Field (Specify Requirements) --- --------------j_-3o-----------49-r- --------------------0- <br /> 4 <br /> ------------- <br /> ------------- <br /> ------------- ------- <br /> ---------------- <br /> ------------- -------- ------------------------------------------------------------------------------ --- --- <br /> ed addition on reverse side) I <br /> (Draw existing and required <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, Statel Laws, and Rules and Regulations of the Son Joaquin Local Hebith District ome owner or licen <br /> sed agents signature certifies the following: play any person in such manner ' <br /> "I certify hat in the performance of the-work for which this permit is.issued,-1 shall not ernF <br /> at <br /> e m Ju <br /> III laws of California." <br /> 3je to orkma 's Co"e 10 1 <br /> as to be me sub ct <br /> ---------------------- Owr <br /> Signed <br /> Title ---- ---------------- --------- ------Z----------------------------------- <br /> By ------- -------------------------------------------------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY 11 <br /> A P P L I C AT0 N-AC C E PJE B Y_ :R -- - --- DAT5:! 77�1 <br /> F-71------------ <br /> BUILDING PERMIT ISSUED <br /> ----- TE'_----------------------- ----------------- <br /> ----------------------------------------------------L------------------------- ------------L------- --- F <br /> ADDITIONAL COMMENTS --- ----------L__L-­-------, ----- - ---------------------- ------- ------------ <br /> ------------ - ----------------------------------------L-------------------------------------------------------------------------------- <br /> --- <br /> -- -- - -- ----- <br /> -- --------------------- <br /> -------------- <br /> -------- --------!-------:--------- ------------ ----- - --- ---------I----- ----------------------- <br /> -- ------------------- L----------------- --- ----- ----- 7 ---- --- ----- -------------------------------------------- <br /> ------- ----- <br /> ----------- --- <br /> Final--­­ - -- ---------- -- --- --------- e <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> rLL E.,H.,._9 1-'68 Rev. 5M <br />