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60`k &;Rfd USE: I APPLICATION FOR SANITATION PhRMIT �S <br /> Permit No. ..._..-----•----..... <br /> ......................................................... (Complete In Trlpllcate11 7-1- <br /> Date issued ................./7 ... k <br /> .......... ................................. f <br /> ..................................... <br /> This Permit Expires 7 Year From Dale issued <br /> Application is <br /> hereb mode to the Joaquin Local Health District for a permit to construct and install the work herein <br /> y <br /> ication Is made in comp <br /> described. This applliance with County Ordinance No. 549 and existing Rules and Regulations: E <br /> 1 f� .................. CENSUS TRACT .... . . <br /> JOB ADDRESS/LOCATION ..._..._.�' Phone <br /> ....... <br /> 51 Owner's Name ....�.....�........... f�- ----....•-•........................ <br /> Address ..........l.l.� �r--..... Cdr .License # �. + _ hone a .y-/4 <br /> ------• ----- • <br /> Contractors Name ----- �_..__/- ---- � _ <br /> ta!OT- roller Court ❑ <br /> Installation will serve: Residence Apartment House❑ Corninerc �� <br /> i Motel C]Other---------------------------•- -----.-----•-•- iZe - <br /> lot S . . <br /> 4 -�Y <br /> Garbage Grinder _...-------- � � • <br /> Number of living units:---- Number of bedrooms ---•-----••- Private <br /> Water Supply: Public System and name ------------ »`----•----- ------------------- - ." � i <br /> Silt Clay ❑ Pebt,❑ Sandy Loam Clay Loom 0 <br /> I Character of soil to a depth of 3 feet: Sand ID ❑ y „- 1 � <br /> Adobe❑ Mill Material ......... If yes,type .......#...... ............ <br /> Hardpan ❑ a <br /> (Plot plan, showing size of lot, Location of sys#err►' in relation A wells, buildings, etc. must be placed on reverse side.) <br /> 1 <br /> E NEW INSTALLATION: (No septic tank or seepage pit permitted.if'•public sewer is available within 20Q feet,) r <br /> i 'L liquid Depth --•-----_...•-••----.....,� <br /> PACKAGE TREATMENT [ j SEPTIC TANK{ j I i j t <br /> 99 Mater al...-----•------- ---- No. Compartments --....---- -� <br /> Capacity -------------------- Type ------•--------- <br /> I •---Foundation -.-------�----• �Prop. Line .. � S <br /> l Distance to nearest: Weil ....... ................ . ! <br /> Leng h of each line---------------------------- Total Length ,.._...._:.... <br /> LEACHING LINE [ ) <br /> No. of Lines ------------•--;,� <br /> _De Depth Filter Material --•--•---•................................._ <br /> 'D' Box -_........._ Type Filter Material _..---•.----------- P ) <br /> i Distance to nearest: Well ...:.................... Foundation ...............•-- • .. Prop rty Line ... .... -- ...... <br /> . Number - - . Rock;Filled Yes ❑ No <br /> Depth Diameter --------------•-.•.._. _ <br /> SEEPAGE PIT O p ---- C <br /> ----Rock Size •- - <br /> Water Table Depth _--_------• .. -------------- ------ --• <br /> - <br /> .Foundation ----•- ...----_. Prop. Line ..... <br /> Distance to nearest: Well ---------�-"--•------------•------- E <br /> ,i .. -•--•-) <br /> REPAIR/ADDITION(Prev. Sanitation Permit .............. -------- Date -...---,, <br /> yl --- •••. �T <br /> Septic Tank (Specify Requirements) ------- --------------------�'"•-----y----••- � � �.. <br /> I i . - <br /> _ --- ��...... . Q..... . <br /> s Disposal Field (Specify Requirements) /�-C�a -•- J.••-- ' <br /> t <br /> ----- �✓ <br /> ---- ------------------- <br /> ---------------- . . <br /> r ---- -------- - <br /> --•--------•-------- ----------------------------- - .� <br /> (Draw►existing and required addition on reverse side) <br /> 110-. / <br /> I hereby certify that i have prepared this application andof iiiacco <br /> a San Joaquin Local oHealth Distriit <br /> County Ordinances, State La with <br /> ce eitowner oJoaquin <br /> Iicann <br /> ws, and Rules and Regulationst <br /> sed agents signature certifies the following: , <br /> k I certify that in the performance of the work far which this permit is issued, 1 shall not employ any person in such manner <br /> ' as to become <br /> �Voto ork an's Compensation Taws of California." <br /> 1. Signed .121. . ..--------•---------•- --------•-- Owner <br /> ». <br /> .._:.--.... -------------- <br /> (If <br /> ------- <br /> Title ............. ...... --------•----- <br /> By <br /> ------------------------------------------------ <br /> If other than owner) , <br /> rOR-,DEPARTMFNT`USE:-O�+)i•Y <br /> -+,-�_..__._ DATE <br /> `75---- .. <br /> APPLICATION ACCEPTED BY _ ---- - --• ------- <br /> -..... . <br /> BUILDING PERMIT ISSUED ._------------_­------------------------------------- ----- <br /> -DATE -• <br /> j ADDITIONAL COMMENTS ------------------------- -------------------------------------- ...... <br /> i <br /> ................ ...._.._._.. <br /> - <br /> ..--•--......I-------_----- ---------- Bate ........ <br /> Final Inspection by: •--------------= ------- ��'} <br /> EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT $��� 3M <br />