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�+ ariC.t V5E" <br /> r APPLICATIONFOR sANIrATION PERMIT <br /> .. <br /> r............. (Complete in,,Tripliclatel Permit No. <br /> �. <br /> :..................__........_....._...... This Permit Expires I Year from Dot*Issued x x <br /> Doti issued .zZ:.1-:.?.-,� <br /> ( Application is hereby made to the San Joaquin Local Health District for a permit to construct n�a._�7 <br /> j {•described. This application is made in compiiance with County Ordinance Na. it t and <br /> and install the work herein <br /> JOB ADDRI_SS/LOCATION . ex st ng WTAa <br /> Regulations: <br /> Owner's Na C� - ....- <br /> Name _ <br /> _ •-..CE SU ...... <br /> �._....•--•-• <br /> Address ..... .._..._... <br /> � �'-'1}._.._ L ............................Phone ..._...............,. <br /> � •--- Ci .............Contractor's Nome _.. ......... <br /> •- •...................... ........._...................--- <br /> Installation will serve: Phone <br /> Residence©Apartment Ouse 0 Commercial oTraifer Court <br /> Motel ❑Other.._.._-- <br /> Number of living units:....d._----- Number of bedrooms <br /> .....Garbage Grinder ....__...... Lot Si <br /> Water Supply; Public System and nam za `� <br /> F Character a .............. --•----...__... .. <br /> Of soil#o ------•-----•-•--...._..-•---- <br /> a depth of 3 feet: _..---.._-- <br /> - •---•-•--•- ..Private 0 <br /> Sand � Silt[] Clay [� Peat[) Sandy Loam .................... . <br /> fl Clay Loam 0Hard an Adobe flFill <br /> Material ............ If yes,type .............. <br /> (Plot Alan, showing size of lot, location of system in relation to webs buil <br /> NEW INSTALLATION• dings, etc. mus <br /> (No septic tank or seepage pit permitted if public sewer is availablet be plated on reverse side.) <br /> PACKAGE TREATMENT f ) SEPTIC TANK[ ] within 2QD feet,# �1 <br /> Capacity .!. �� Size...Y_• V.Z.._ yujo.... .._... Liquid Depth <br /> . Type . - Material.......... ... No. <br /> ' .._.. Compartments .... <br /> Distance to nearest: Well _-_-� - ...._,...�._ <br /> LEACHING LINE 1!57—e -••----------------Foundation ..... ... ' <br /> [ ] No. of Lines ----.. Prop. Line ... .. <br /> -----­3 Length of each line__-- - (�'.. £: <br /> 'D' Box ._f-_.... T ��" <br /> _.--• Total Length .__ .. ' <br /> Type Fiiter Material ._.._. .._ De th Filter Material <br /> Distance to nearest: Well _....---._._ p ... <br /> ....._._.:_. Foundation --••-•---•-•- <br /> SEEPAGE PIT j .............. ........ Properly Line .. .... <br /> �,� � � Depth -----------------__. Diameter "` ................. <br /> Number ....... <br /> Rock Filled Yes r] No <br /> Water Table Depth ---------------------- _ <br /> ................ <br /> Distance to nearest: Well ---- .-Rock Size ............ ... <br /> ----•----••---- •- E <br /> REPAIR/ADDITION f Prev. Sanitation.Permit# ------...--- Foundation ............ ....... Prop. Line ............:......_. E <br /> ----• Date ----• <br /> Septic Tank (Specify Requirements' <br /> j <br /> --•-----••----••-- <br /> posal Field (Specify Requirements) _-........................... <br /> ---------- <br /> _--------------- <br /> . _-•_•_•__••____••____ ............ ... ..... <br /> .. ........ .. ................................................. <br /> .have prepared this application-'and required <br /> {�a <br /> ! hereby certify that laddition on reverse side) <br /> t the work will be <br /> County Ordinances, State lbws, and Ruses and Regulations of the San J again Local Health,no In Ho with San.Joaquin <br /> sed agents signature certifies the following; me owner or Ilcen. <br /> "I certify that in the performance of the work for,which this permit is issued ! shall net employ an r <br /> as to become subject to Workman's Compensation laws of California." P y y Person In such manner <br /> Signed ..... ------ <br /> ---•-------------- _ <br /> Owner <br /> {� # <br /> (if of er n orldn } Jitie ........ 1 �11_ <br /> FOR DEPARTM NT USE ONLY t <br /> APPLICATION ACCEPTED BY----...._ - <br /> BUILDING'PERMIT ISSUED -_ -- ' ------ K <br /> .- - DATE <br /> .._...---•---- --- ---ADDITIONAL .. ' <br /> ADDITIONAL COMMENTS ---------------------- -- :- .,,..-..:"-..--.-•"r_ <br /> . .__•.---- -DATE - ------ - - - <br /> •-----------------•------------- ------- ----- ------------------•------.'----- ------------•---......--------------- ----•-..._. <br /> Final inspection b <br /> EH 13 24 1-68 iEev. ,c}.I •............... <br /> ................. <br /> ----..Date - ---� ---- ��.... . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT ......... .. .. ..... -- <br /> 8/7h 3M <br />