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APPLICATION .FOR SANITATION pERMIT <br /> �l� 72 <br /> iCom lete In Tri licate Permit No. <br /> W ' <br /> .......-.:``I . <br /> .!... ... Thl 7� r � Date Issued . ..............-7 <br /> s Permit Expires 1 Year Fr4re►`T?ofe IssWd <br /> i.o.ni+.ni, — nnnro. <br /> f Application is hereby made to the Son Joaquin local Health District for a permit to construct and instal) the work herein <br /> described. This application is made In compliance with County Ordinance a. 519 and existing Rules and Regulatims, <br /> JOB ADDRESSAOCATION OV9_ , t:,....., !`.. D,,l' ..�t .. . ... .... `�....,.CENSUS TRA <br /> C Q ....... <br /> Owner's Ndrae '! % ..... '! /� ...... Phorts <br /> :.. Address . - .5 + G .,City <br /> Contractor's Name ....-. J?x�i ..: .............. ..... ........._... <br /> ..�.. .....license # ........................ Phone .............................. <br /> Installation will serve: Residence Apartment House C3 Commercial OTraller Court ID <br /> Motel❑Other ..... ............................... <br /> Number of living units:...�..-. Number of bedrooms ..." .....Garbaga Grinder .. .. Lot Size � T. <br /> r Water Supply: Public System and name ......................................... .... .... ........ <br /> .. ......... <br /> Choracte►of soil to a depth of 3 fest: Sand E3 Sift❑ Clay 0 Peat(j Sandy Loatrl Clay loam (j <br /> Hardpan Q Adobe❑ Fill Material ............ if yes,type............... :...... ... <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed 6n,reverse side.) <br /> NEIN INSTALLATION: (No septic tank or seepage pit permitted if.p bll sewer€s available within 244 feet,) <br /> PACKAGE TREATMENT { } SEPTI TANK; � If. 0, liquid Depth . ` <br /> 7.Capacity ....... T �` "'J .... ..........•tg&h� ........ ......_ ........... <br /> ty Type .i.. material..................... o, Compartments .,r..... <br /> Distance to nes tz Well ... d¢.............. . . ` " <br /> .1=ovn�tiop ...................... Prop. Lirts .�. <br /> .LEACHING LINE l I No. of Lirtes ... ................. Length .epQcis lne...........�J.............. r.T..,740,...... .:. <br /> T Total Length • <br /> 'D' Box ............ Type Filter l�atripl ......... .Depth F,IheTrMaterial y <br /> K. <br /> Distance to nearest, Well ........................ Foundation ....: -..............._. Property Line` . ....... <br /> ,iEEPAGE PIT ( j Depth ...................•Diameter Number , ............ <br /> ------ _.. Rack Filled Yes ❑ No <br /> WaterTable Depth ................................................Rock Size ................................ <br /> Distance to nearest, Well ........................................Foundation ........ <br /> REPAIR/ADDITION Prev. ' .........,.+ Prop. lin* ............... <br /> i Sanitation Permit# ............................................ Date ................................... <br /> SepticTank (Specify Requirements) ......................................... ....................._......................................... ..........._.......... .. . <br /> Disposal Field (Specify Requirements) ......... <br /> ................................:............................................ .......... <br /> ................................_............................................................................................................................:......_................ <br /> (Draw existing and required'add€tion an reverse side).......................................................... <br /> I heraby certify that I have prepared this application and that the wok will be done In accordance with San Joaquin <br />: County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Hanes owner or lice <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of tho work for which this permit is issued, 1 shall not anploy any person in such manner <br /> as to b .on� v� � sar_ mia Corpei of California. <br /> Signed .. .............. <br /> •---•- ............... ....... ........................ Owner <br /> By ............ ...... -.... title <br /> ......nee.........---••...................................... <br /> [if other than owner} ........................................................................ <br /> • --�� — OrDEPATMENT USE ONLY - <br /> APPLICATION ACCEPTED BY Oro r <br /> BUILDING PERMIT ISSUED ....................... .:.................................................... <br /> ......... <br /> ...... <br /> .................... <br /> .... DATE .. .............................. . <br /> ADDITIONALCOMMENTS.................................................................................................:..........DATE.�........... .......................�. <br /> ..................................................................................................... .:::.:..::::::::::::::::::......................................... i <br /> Finalinspection by: ..... ............................................................................................................ .................................................. <br /> Ff 13 2� 1—bii .............................................................. ..........Date ............................................ <br /> Rev... SAN .IOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />