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FOR OFFICE U$t <br /> APPLICATION FOR SANITATION PERMIT _ <br /> ,l U ................ <br /> :.......... 1Cornpleh#n Triplicate) W.. : o _ Permit No 2:�`` <br /> .... ... .... ......•--- ....................... This Perfnit Expires Z Year From Date Issued - Date Issued <br /> ...........f!!. rr, z :E. Co s r-v ,� ,J Cj`I/- (�qo=.�2 <br /> '�4 plication is here�y made to the San Jadqui%�'1oeal Health District for a permit to construct and install the work herein <br /> dgscribed. This angliention Is suede in.-compliance with County Ordinance No. 519 and existing Rules and Regulations: .. <br /> I6 <br /> 3:0B <br /> ADD <br /> • - <br /> �t ..................CEN5JS � ..._.. ............... <br /> r <br /> , i- <br /> .................. ...... -•--._.:Phone ........Name <br /> J <br /> .. City <br /> Contractor's Name ----• - f _ ..•..:..__.....................License il` /�'e, Phone <br /> Installation will serve: �Residenceiod Apartrtlent House C3 Commercial DTraller-Court ❑ <br /> r <br /> 1 <br /> Motel 0 Other......................... <br /> g units:_._---:_ umber of bedrooms _.....Garbage Grinder d_. lot Size �t'E <br /> Number of livinrs :_---•-- <br /> Water Supply: Public System and narna ..-_.--•- __ _..::':�"` ............... _.. :..._.:_....:........-•---...�...:.......Private�. .� <br /> �;• i <br /> Character of soil to a depth of 3#eget: Sand Silt Clay PeatW _•• Sand la + <br /> . � �7 C3 Y ❑ a ❑ Y loam Clay Loam� <br /> ` Hardpan 0 Adobe 0 F€ll.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 jeepage pitl'Oermitted if public sewer 1s'availoble within 240 feet,) <br /> . PACKAGE TREATMENT---[] SEPTIC.-TANK Q --- -- � ' Size.. .; ..► 'i. .1't ........ Liquid Depth . f. .... -- <br /> • iii 1 <br /> Capacityl,l �ss.-•_-- Type ' . Materlal. t7�,�r x. No. Compartments .. :............. <br /> Distance:.to nearest: Well M.,c�+.e� ...............Foundation . l Prop. line . _. <br /> f <br /> LEACHING LINE No. of lines r.__._ : . Length off each line-:,� f,1�.... ... Total length 14.19................ <br /> to <br /> 'D' BoxType Filter Material` � Depth:.Filter Material .. ...... <br /> Distancenearest: Well ., �__..•....�. Foundation ./..�.�.:..--:__i--- Property Line .. .. ... <br /> SEEPAGE PIT Depth . Diameter / s ._�. Rock Filled ;Yes No � <br /> . .�.. .- ... . Number :.._.. �o <br /> ...:.................... -� � ! <br /> M > st <br /> Water Table Depth -:---__�f� ....._..Rock Size .�. -• <br /> i � <br /> �...... <br /> Distance to nearest: Wef �' .�� Founddition Pr Line . <br /> REPAIR/ADDITIONIPrev. Sanitation Permit# �_......._... ............... . f <br /> € -- J- -•-• -•- -. Date - •. ............. -! <br /> Septic Tdnk (Specify Requirements) r - .. .. !/Y I .......... .................. <br /> _.... <br /> Disposal -Field ISpecify Requirements) '••-•--•-•-•..:........ .--_:-.....•-----•..._._....._..............._.:_.........--- <br /> • !� .4 r7 <br /> ---•--•---- -------------------- ..............................................;.!t...............• ......• ........... .................. <br /> Ip•-••---- ------ <br /> ------------------- ---•--- ............. . . ....................W..........._..............................................._....._......... ..---......... <br /> F <br /> r� (Draw existing and required addition on reverse s€de). <br /> I hereby certify that I have preppred this application and that the work will be done in accordance with San Joagsale <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health:District. Hort* owner or liven• <br /> sed agents signature certifies the following: <br /> "I rectify that in the performance;!of the-*ork for which this permit 4 lsssied, 1 shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laves of California." . <br /> Signed ........... •---•- -- --•- !� .. - Owner <br /> ------------- ----------- <br /> BY ..-- .•..-- ...... r ------------- ............... Title :� _ � ._. � <br /> othePhan owner] .. <br /> FOUR DEPA TMENT USE ONLY <br /> APPLICATION ACCEPTED BY tac f .-- ----.`___.. ..............-,. DATE.__.7=1,%�/�7-5......:......... <br /> BUILDING PERMIT ISSUED ----------.`: � <br /> ...... .-. .. --------- - ---- •-•-- ••-------•---.D ....,....:..:.....................: .!.. <br /> ADDITIONAL COMMENTS ...........iM ...... r --- <br /> •------:------- ---. <br /> • ._. ............ . ........... <br /> > , . r i , , .. . , ,. <br /> .-. _..........._...................__..... ._ <br /> ...................................................... <br /> ----------------------------------- <br /> _........... •........................................................... W.. <br /> Final inspection b : . �C�=:.'1 .... :........ `............. <br /> ................... Date ........_......................_.-.......... <br /> EH <br /> 13 '2L 1 -6 ile SAM JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />�F ' <br />