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FOR OFFICE USE= .... APKICATMN FOR SANITATION PERMIT ` <br /> �... ........................... Permit <br /> \ lCompiete in Triplicates .'.. . <br /> "`.............. Date Issued -114..Z.24r <br />........................... ............................. This Permit Expires 1 Year From Dab Issued <br /> Dis <br /> Application� ' happlicatreby m on Is t deIn an Joaquin a Local Health Co ty rict for a Ordinance No. 549 and existingrmit to �tRulestall the work herein <br /> and R utatlonst <br /> JOB ADDRESS/L0 TION , <br /> .. . ........ .... ....................LtK--..............................................CENSUS TRACT . ..................... <br /> Owner's Name 1.? -v! ......................................................... ... ............ ...............Phone .......... ..................... <br /> Address ..a-./..tFl.Jo. .��.... . ' ,�?:... .........................................a City ..:���� ..................... .. ®® ... <br /> Contractor's Name .� ...- . . ....................................................License # . 1'Phone <br /> i <br /> Installation will servti esidence UV4artmont House Q Commercial[]Trolls►Court 0 <br /> Motel❑Other............................................ <br /> Number of living units=............ Number of bedrooms .......Garbage Grinder ............ Lot Size ....... <br /> Water Supply: Public System and name ...................... ......................................._.......................................LPrivrsie <br /> i` <br /> Character of soil to a depth of 3 feet= Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Lown❑ Clay,Boom <br /> Hardpan❑ Adobe❑ fill Moterlol............If yes,type.............. ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, ete. must be plo* on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 2PO feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK J ) Size. ..................... ................. Liquid jttspth .......................... <br /> Capacity �'f pe .1.o� r�Moterial...................... No. Comp Ftments ..2............ <br /> ' Distance to nearest= Well" ...Xm. .. ...................Foundation .................... Orop. line........ ....---- <br /> LEACHING LiNE [ j No. of Lines ..S................. Length of each line...�f•�._...... ._ <br /> .. .........Total Length ..Ise.......... . <br /> 'D• Box .-I....... Type Filter Material .....Depth Filter Motet . .............................. <br /> Distance to nearest= Well Foundation ........................ Property Line ................... <br /> SEEPAGE PIT [ ) Depth Diameter ................ Number ............................ Rack Filled Yes ❑ No <br /> Water Table Depth ................................................Rock Size ................................ <br /> Distance to nearest: Well •.......................................Foundation .................,.. Prop. Line .............,-..-. <br /> REPAIR/ADDITION)Prov. Sanitation Permit# ............................................ Date _............ ......... .[ #` <br /> Septic Tank (Specify Requirements) ......................................... ............ ............................ ...... <br /> Disposal Fielo (Specify Requirements) .................................................................................. .. ............................... ..j......... <br /> ......................................................................................................................................................................................................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done fail accordance With San J6040irt <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Herne ewner er li cew <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 M such manlier <br /> as to b*com_o subject to Workman's ompensation laws of California." <br /> Signed ---4 . .._r.... ........................................................ Owner <br /> By ... yitle .......................................... <br /> lif other than owner) <br /> PAR T USE ONLY <br /> APPLICATION ACCEPTED BY .. ... •.Y... ...................... t:..... DATE <br /> BUILDING PERMIT ISSUED . . ...... .. ... ..... .::.. .. <br /> . „`.._ <br /> ADDITIONAL COMMENTS .tr°c.�,. . ....... . <br /> .tea-��-�•--r ... ��•r .;, <br /> .......................................................................................................................................... ... ...................................................... . <br /> ............................. ....--.. :,...................------.............- ..................-:........................................ <br /> ............................ .. ... . ..... _... .. .......-.- -- ...... <br /> . <br /> Final Inspection by � '� ........Date . ........ .... <br /> EH 13 24 1-68 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT ' 8i/7h 3M <br />