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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION, PERMIT 17 1/15 <br /> ..Permit------ (CompNo- --------------- <br /> ------ - ------------ -- <br /> ---- - <br /> 0 Date-Issued-------------------------- <br /> This Permit Expires I Year From Date Issuedti., )4 <br /> --------------- <br /> uct and. installl'the,Worl�_hefein <br /> Application is hereby made to the San Joaquin Local Health District for a permit to 'cOnstr <br /> x <br /> pp ' at' compliance with County Ordinance No. 549 and existing Rules and Reg '-:tion <br /> described. This application is made in <br /> 7c. <br /> ----------- CENSUS TRACT <br /> JOB ADDRESS/LOCATION <br /> Phone ------------------ <br /> 9.3 F <br /> Owner's Namie ------ ----------------------- ---- --------- --- ---- <br /> - ------K:_1--------- ------------- <br /> city - ---- - --- ---- ------ <br /> Address/-57 ---- -- <br /> Li se # ----- <br /> Contractor's Name License - ------------------ Phone <br /> I ApartmenfMouse-171 �Cdmmercial .[]Tra.'lle'r Court [1 <br /> Installation will serve. Residence X <br /> Motel F-1 Other ------ t----------------------------------- <br /> Number of Ii I ving units..---3.- Number of bedrooms ._______:___Garbage q(kr)0er._T----- ---- Lot Sizea__,cz^_,,k.1f_o—------------------ <br /> rivate <br /> Water Supply. Public System and name ----------------------------------7--------------- ------e�-------------------------- <br /> _L ;mk _.Clay Loam :EJ <br /> Son y 0 <br /> Clay F Peat E]Ak­.. <br /> t--7,San-&E7�Silt 0 <br /> Character of soil to.a,depth of,3 fee <br /> _4� t ---------------------------- <br /> Hardpan ❑ Adobe F1 11 Material If yes, type <br /> side.) <br /> etc. must be placed on reverse <br /> (Plot plan, shoWing. size,of,lot,4oca;1on of system in relation to wells, buildings, <br /> 4.. _.� ble.within 200 feet;)(No-se tank or seepage pit permitted if public sewer is availd <br /> NEW INSTALLATION: 4 Liquid,Depth ----- - <br /> -------- <br /> Size_ ------ <br /> PACKAGE TREATMENT SEPTIC TANK:��� <br /> -- ---------- <br /> Capacity ----- Type 03F-1613 Materi 0. 'Compartments _49-1-------- <br /> ---------- 11 <br /> Foundation -------------­ Prop. Line <br /> Distance to nearest. Well -_____-____75-" ---,A-'(--- ------F <br /> - _k th <br /> ....... Total'Leng <br /> LEACHING LINE of .Lines p,5�x------------------ Length of eac line -15. ... , <br /> 6X --------------------------------- <br /> ------------- pth Filter ateria <br /> D' Box -------- --- Type Filter Materi?l <br /> )n .-IA9--- - ---- 4� Property Line JFAI---- <br /> ------ Foundation Filter <br /> ----- <br /> Dista to nearest. We <br /> Filled Yes No <br /> mw ,---''Rock'.. 4 X <br /> _A'Rk� Number ----- <br /> Diameter mom -2 <br /> SEEPAGE PIT Deptr <br /> Water T <br /> able Depth - ----- -------------------Rock Size <br /> - ---- <br /> &------ <br /> Distance to nearest- <br /> Weil 1C _ - Foundation P(op.,Line 4 <br /> ----- Date ----------------- <br /> - <br /> REPAF TION(Prev. Sanitation Permit -- ---------- <br /> SSeptic Tank (Specify Requirements) ------ - --- -- -- <br /> ep -- - ---------------- <br /> _4----- ---------------------- <br /> d! ----------- <br /> Disposal Field (Specify Requirements) -----aJ5;V-- ----- <br /> ----------------- <br /> ------ ----- ---/F-ACO-----41 N-E7�------- -- ---------- ------- ------------ <br /> -,Z- ------------------------ <br /> ----------------------------------------- <br /> ­_i----------------------------- <br /> -------------------- ----------------------- --- <br /> ---------- {Draw existing and required addition on-reverse side) <br /> ­. - -- 1L.1— — __­­ -- -;r� San Joiiiquin <br /> by certify that I have prepared this application and that the work will he done in accordance with <br /> I here County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following- or which this permit is issued, I shall not employ any person in such manner <br /> "I certify that in the performance of the work f <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------- -------- ------------------- <br /> Owner <br /> -—-------- <br /> 7 -------- ;Title ------ <br /> By <br /> (if <br /> other than <br /> R PAitTMENT USE ONLY <br /> DATE ----- -- -------- <br /> APPLICATION ACCEPTED BY ------ ---IRAID----------------------------,-------- <br /> 4 ---------DATE ------------------------------------ <br /> BUILDING PERMIT ISSUED -------------------- - -------------------------------------------------- 5r --------------------------I------- ----------------­ <br /> ""' ­- i - -------- ---------- <br /> '�OMMIN ------ ---- <br /> ADDITIONAL COMMENTS ------------ --- -------- - ------ ----------------- ------- <br /> ---------------------------------------------------------------------------- <br /> .. -- ----- <br /> --- --- ------ --------- ------ -- ------------------- ---- ----- ----------- <br /> ---------------------------------- - --- ---------------------------- <br /> ----------------------------------------- -------- <br /> ...... ----- ---------- ------- - --------------------- --- ---- Y?7 <br /> ------- ------------------------------ --------------------- - --- ----- <br /> ... -- -- ----- -- ------------ <br /> ------------------------------- <br /> ------ -------- - - -- -------- ------- -- ---- <br /> - ---- ------- --- --- <br /> P. <br /> -Final Inspe - -------------- --_ ----017 <br /> --------- -------------------- ----- Date <br /> SAN JOAQUIN LOCAL HEALTH `DISTRICT <br /> E. H. 9 1268 Rev. 5M <br />