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OFFICE l APPLICATION FOR SANITATION PERMIT i:srm it No <br /> .. <br />......... .......El--...... y ?. <br /> (CottipleH in Triplicate) <br /> .... ........... <br />.•••••• • . �Y _ ; ..._._ _ this Permit Expires y Year Freitr'Oah Isiued ! <br /> and <br /> herein <br /> Application Is hereby made to the San Joaquin ance Local Health h Cou D1 tOrdinarict rnce No. 549 armit. to nd ex at tt�Rulesinstall,-the <br /> and hRegula ions, <br /> described. This application is made In compliance i L <br /> ,�: 1?. . ..... � ��y'.... .�.J.14 ...............cEi esus TRACT ... .....:. . ............. <br /> JOB ADDRESS/LOCATI .. I <br /> .. . . l �Q cI... ..Phone • ' . .. <br /> Owner's Name .......... C?t� ........ ................ i <br /> Address ...................... .. Phone <br /> Contractor's Name ..._..-- <br /> e! f/i� li:1 / .� �+ hucll•4.'•...License r <br /> Installation will servet Residence Pf.Apartment House[] Commercial oTrallw Court Q <br /> Motet 0 Other_............... ___-----.........-- r fi'`C.. -4'740; '� *-. ... <br /> a Grinder . Lot Size • ....., <br /> Number of living units,..../-....Number of 6adr om .. .. 9 .. .w.............. •--- -- --...------ W <br /> Water Supply% Public System and name ........ <br /> J -.... -• -. -- '-- <br /> Peat Sandy Loam ❑ Clay Loom 0 <br /> Character of sall to a depth of 3 feet; Sand 0 Silt❑ Clay ❑ ❑ <br /> Hardpan Adobe FIII..Materio! ........if yes,type...-•.......... ............ V <br /> -[Plat plan, showing size of lot, location of system!In'relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEIN INSTALLATION: septic tank or seepaga pit permitted if public sower Is/available within 20Q#eet,) <br /> ..� ,�.? / prf/._....... Liquid Depth <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ] Sixe... . . . .. <br /> �_.. <br /> Capacity . A,/Type .. [ Materia! 7 .�� No. Com artments .. .............. <br /> l Prop. L1ne . �- <br /> 1�0Distance to nearest: Well .._ �'.f -----••• --Fou dation ___.-- <br /> • ... T al Length ..- ^, .... <br /> LEACHING LINE I l No. of Lines ... / ..... Length of ead� }lne._ :. - ••. ._....... <br /> - ' .-i <br /> qtr' `D' Box Type Filter AAataria},, ����.�Depth Filter Material <br /> ` } ........ Property Line ,• -___, .. <br /> Distance to nearesti Well ' 6..••-- Foundation ..... <br /> ' . Diameter '� Number � !tock Filled Yea ❑ <br /> 0 <br /> t Depth SEEPAGE PIT E g p ...._..---•--...._. s .......:....... <br /> ..__ — Water Table Depth I .........................Rock Size ......... ...................... <br /> Distance to nearesh Well ......................................... <br /> Foundation _..•................ Line ...... ......_.. <br /> REPAIR/ADDITION(Prov. Sanitation Permit 5 •• ...................................... Date ...--'.................---'.... ....._........... ............. <br /> I Septic Tank (Specify Requirements) ......... .. - -.... .. ----•-- c <br /> 4 Dis oral Field lSpedfy Require <br /> ...................I............. ................. <br /> p ...................•-•- ----........_..............---• ...__.........--...._..- _--_____......._... . ......._-....... ......A " ......__........._............ <br /> .......-- # ' <br /> x .._....... ............................... <br /> s _................................. i <br /> ........................ s <br /> ......................... [Drove existing and_requiredpddition on reverse.-side) <br /> ° ! hereby certify that l have prepa+'erl tltls pisllcation and the; &work will be done in accordance with San Jea+la n. <br /> County Ordinances, state laws, and Rules an Regulations o/f the San Joaquin Local Health District. Horns owner of ilcen- <br /> { sed agents signature certifies the fella;yIngNn ,c s — <br /> "I certify that In the performance of the work.farinritich,this pormit`is issued, I shall-not emplay any person in inch manner <br /> y � -{ <br /> as to become sub a <br /> Workman's Compensation law f Cdlifi rynla <br /> yam ^ •6 <br /> Signed .. ,�,. r r` . ff��yy Owner �[ <br /> S ... ` •• f ........ .......: Title- <br /> .......... <br /> itle ........_........... <br /> By � " <br /> i <br /> [if other than owner) `F <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..._........................ DATE ....... <br /> ................. <br /> _ <br /> BUILDING PERMIT ISSUED ..... ... ........................................................ <br /> ...........:._._..v....................:DATE ......._. ...... <br /> k ADDITIONAL COMMENTS .......................... ....................................................... <br /> .....__............................._.. <br /> . .....................•------......_...__..._....._.... �...---...•........ <br /> ....... <br /> 5 <br /> ..................... . . . Dale ... .�. . . �..............._.... <br /> Final Inspection by: ................. <br /> . / ....._... . . ..... ................,... <br /> EH 13 24 1-68 -Rev. 5M SAN OAQUIN LOCAL HEALTH DISTRICT �� <br />