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FOR OFFICE USE: APPt1CATIOWFOR SANITATION PERMIT <br /> .................................................. -0,- I., Permit No. .._. ................ <br /> -(Complete in Triplicate) <br /> ........................................ <br /> This Permit Expires 1 Year From Date Issued <br /> . Date Issued ...- + <br /> ........................ ............................ I <br />{ Application is hereby made to the'Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regutationsc <br /> JOB ADDRESS/LOCATION 1.715 ........../Wj0JVT.-5r.........Lf1VDeN...................CENSUS TRACT .......................... <br /> Owner's Name ...Z.O-E.....W..it..VSTRAD-•---_----•-••---_ --••-•-•---- ......•..........:........:............Phone <br /> Address .---------3.0... !,_­oet --� Ci ......�'��.�C.'.�a1'b�.............................••.... <br /> Contractor's Name _._ Q ._.:__lN.i!* Aye_------------•.................License # -------- •----•-- Phone ..&/, _2 7f7a .. <br /> Installation will serve: Residence 10 Apartment House fl Commercial OTra.iler Court 0 <br /> Motel ❑Other .--•--- ------------------•----••--------•-• <br /> Number of living units:---- Number of bedrooms.:.......Garbage Grinder:'. A/*. Lot Size <br /> � = <br />: Water Supply: Public System and name ... <br /> -j0. �t .........---Y.Vw • .......01,6M...................-.....Private ❑ <br /> Character of soil too depth of 3 feet: Sand❑ Silt Q Clay .0 Peat❑ Sandy LoamA Clay.Loam 0 <br /> Hardpan❑ Adobe 0 Fi1I Mwaterial ...... Ifyes,type <br /> .............:. :........... <br /> f. <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 seepage pit permitted if public sewer is available within 200 feet,} p <br /> PACKAGE TREATMENT { ] SEPTIC TANK f ] Size.........� i Q. '.' ) liquid Depth .....V.4.........:. <br /> Capacity ffjAC , Material No. Compartments .___. ..._ <br /> p tY ���Q. Type •... <br /> Distance to nearest: Well .__.....)..,�::'.0................Foundation -----/__.7:^.O..... Prop. Line ---�s�..�.....� <br /> Total Len th .._. �...-_.-...� <br /> LEACkIING LINE [ ] Ido. of Lines ----- -•---- ------ Length P�Ea j{rim. �G.------- g <br /> 'D' Box ............ Type Filter Material __ 1; ........Depth Filter Material ........... ......................... <br /> f, S F� __ Foundation ,2.+5 Q?N: f5,!a.. <br /> Distance #o .nearest: Well ---.�J.- --.--- ---- - ----•--•- - Property line .....-- - <br /> SEEPAGE PIT ( ] Depth Diameter W Number Rock Filled Yes 0 No <br /> Water Table Depth ................... ....Rock Size <br /> 4 <br /> i Distance to nearest:,Well ------------*........................:..Foundation ............. ...... Prop. Line ...................... <br /> k <br />' REPAIR/ADDITION(Prev. Sanitation Permit -------------------------------------------- Date ..................----__---------) <br /> SepticTank (Specify Requireme.ntsl ........................................................_..........--••-•---••----........................................................... ► <br /> Disposal Field (Specify Requirements) -----....... -••-----••--•................ :..............._._ <br /> ----------------------------------------------- ------------------------------------------------------*-------------------- ----------------------------------•- --•-------- ------------ <br /> i -----------.......................... I ----------------- -------------------------- ----------•-•------------.-.- ••---......... <br /> I (Draw existing and required addition on reverse side) <br /> i i hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or 11cen- <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 /> I as to become bjec# to Wo kman's C p cation ws of California." <br /> . . <br /> Signed -7,.�r� <br /> By ....._... ------•--- - Yale - <br /> ......----•---- ...... <br /> (If other than owner) <br /> FOR RTMENT LISF ONLY <br /> APPLICATION ACCEPTED BY . ...... ...... . -------------------------- DATE J . ........... <br /> BUILDING PERMIT ISSUED ................................................•..•--. ..DATE ........................... <br /> .._ .............. <br /> ADDITIONAL COMMENTS ....................: . . <br /> ----------------------I--- ----------------.__...........................................-........-----...._....------._............,.................... <br /> ...--------- ------ --------- <br /> ------- ......:.............. ... .... - <br /> Final Inspection by: . .._ ._.._ Date <br /> EH 13 2!� 1-613 v. 5A4 SAN JOAZ.. <br /> LOCAL HEALTH DISTRICT 8/7h 3M <br /> 4 <br />