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FOR OFFICE uSE,__C17 <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> .I (Complete In Triplicate) <br /> ......... ... ..........4 .� _ _ - Date issued <br /> . This Permit-Expire!: ft1Q wFrotn-Dahtssued`� <br /> Application Is hereby made o the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This applicotio�i is:Made in compliance with County Ordinance Na. 549 and existing Rules and Regulations- <br /> JOB ADDRESS/LOCATION ..--.J.�QII!2 .,.. � .........R.Q.=.......... 77Cf�.....c�Nsus RA�:r <br /> Owner's Name ---- -------�it s.cH.....-------•..............:................... <br /> ...............................Phone . �`? _".�� E--•- <br /> Address _ ----..-�Tl<N.---•...............:....•-- ._.._......City ...._5. ..................-----....-•---.......................__ <br /> IContractor's Nome s E __5 G K ......:........License ` ..:....... ......... Phone . .._.__. <br /> Installation will serve-!7, i Residence&Apor tment House f] Commercial oTraller Court 0 <br /> MotelQ Other....:...................................... <br /> I Number a bedrooms _ <br /> -r fGorliage Grinder _ Lot Size .- •- � <br /> Number of living units:... ..._.._ .- ..� <br /> Water Supply: Public Sys 1m aril name . =•.............. . ...........• _.. __.. -......._._.. _ ....-- :.._:..Privet <br /> f e �" <br /> Character of soil to d dept of S feet: Sand 0 Silt❑ Clay Q Peat❑ Sandy Loam )] Clay Loam[] I <br /> Ha?ilpan Q Adobe Fill Mater€al ......If Yes,type ............... . ....... ; <br /> :f dip <br /> ' (Plot pian, showing size :6f lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: �A10 septic tank or seep s=pit-permitted-€f-pubilt-s r-is-availal le within 200 feet) <br /> PACKAGE{7REA7 ENT SEPTIC-1ANK Pf Size. :....1 00 Liquid Depot ......... ......... , .__ <br /> z . -- <br /> k <br /> C Aj!pacify 1� .®.....-- TYI�e E.C����lVlaterial �Compartments <br /> static <br /> LEACHING <br /> to nearest: Well © __{................:.Foundation .... _..`..[.'� Prop. Line <br /> lfiil Length ----. <br /> LEACHING LINE.�,..[y'�..-.-No:Tof-Lines-: ------•-------. Length of each line................ g <br /> ill, .•................. <br /> Gf`�Bax ::.Type Filter Material .l�� .__.Qepth Filter Material .......�[..-.-.•••- <br /> R <br /> . a al, Pro' <br /> ---_-._.- foundation ----fa............ P o'perty Line -.... .SEEPAGE PIT (vf' D',e'pth /7-------------- Diameter3.Xp---:_ Number ..............: .___.__--.. filled Ysa No �]•- <br /> Water <br /> Table Depth '.............•------_--- .....................Rock Size ............................... <br /> i Distance to nearest: Well .................................Foundation ................ Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............... ......-•-- • -•---- Date ..... <br /> Septic Tank (Specify Requirements):........._............••...........................................................-___...--•--•--- .. .. ................. <br /> i 1N • <br /> DisposalField (Specify. Requirements) ---_-------- ..............-..............................=.............•-•--------- ............................................ <br /> 1 •................. <br /> -------•--•-----'--------------------- II�--------------------.:..----------------------------•-------•--- -----•-•••............-------• --•--•• ----------........-•-----•-......... <br /> i <br /> (Draw existing and tequired addition on reverse side) <br /> 1 hereby certify that 1 hve prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinance:, State):Laws, and Rules and Regulations of the Son Joaquin local Health:District. Hance Owner or licen- <br /> wE' <br /> sed agents signature certifies the following: <br /> "I certify that in the perFormance of the work for"which this permit is issued, I shall not employ any person in such manner <br /> as to become bb ie to Workman's Compensation laws of California." <br /> Signed -...- -... ---•.................••--•---• ---- Owner <br /> �.a4k <br /> ------ Title <br /> I <br /> (If other than owner) <br /> f, FOR DEPARTMENT USE ONLY <br /> 0 <br /> APPLICATION ACCEPTED, BYD.�,_.....:-,. _ <br /> BUILDING' PERMIT ISSUED ---------------- - .--........_ --••----._.....DATE ------------------•------- --------•----- <br /> ADDITIONAL COMMENTS ............ .............................----------------------------------___...................___........................................ <br /> .. <br /> -----------•----•- ---------------------'M---•.. ----------------------------------•-• ---••----------------.-..-----------------•�-------•---------...........----...._._..................-•---....---- <br /> 1 •-- -... ---�1 --..----- --- --- ----- -------------- -•--------- --------.---------•..................... --------.....--_- <br /> ------ -- -- ---- <br /> - ----...._..!�-------- ---- ------- ------ <br /> Date ---.r-�- > <br /> Final Inspection by: .. ---- -------- --- <br /> - • ------ . . _ ........I.... ...-•-----------------................ <br /> ............. -_�_. ..._...--- <br /> El 13 2t 1-68 Rev. 5M SAN J AQUIN LOCAL HEALTH DISTRICT 8 74 3M <br />