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FOR OFFICE USE � 7�_ g� <br /> APKICATK" SANITATION PERMIT <br /> i................ ............................... `� )Complete to Triplicatel Permit No. .?2 .��� <br /> �. ................................................. .... y Date issued .ff.f.. .7 <br /> This Permit Expires I Yea From Date Issued <br /> Application Is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work heroin <br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulotions: <br /> JOB ADDRESS/LOCATION ��0,. �✓ �. �" ............CENSUS TRACT .......................... <br /> Owner's Name ........... ................................................. <br /> .r...� ..... ..................Phone .✓1+ y' T- ...... <br /> Address ._...................................... .1141040.......................................City ...... ......... :?:. .1.. .. <br /> Contractor's Name ..................................J(24W ............... . .............license# ........................ Phone ,. ........................... <br /> installation will serve: Residence❑Apartment Commercial O'roNer Court (3 <br /> Motel 40ther....•� ... �� <br /> Number of living units:......I... Number of bedrooms.....,.Garbage Grinder ............ Lot Sin ..... 1i...�............ %N <br /> Water Supply: Public System and name .._.......•................_.............. ._......._ ........ ..........................PrivatiX, O. <br /> Character of soil to a depth of 3 feet: Sand❑ Silt Q Clay ❑ Peat❑ Sandy Loam 0 Clay Loon `. <br /> Hardpan Q Adobe❑ Fill Material ............if yes,type........................... <br /> W'. <br /> (Plot plan, showing size of lot, location of system M relation to wells, buildings, etc. must be placed an reverse skh <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) je <br /> ........... Liquid Dem �....�r'. ......... <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size..........t.. ..��....�.� Liq p <br /> Capacity - Type : :'4 Material.....O..e.AC!.... No. Compartments .... . <br /> Distance to nearest: Welt ., �.`...................Foundation .� .......... Prop. Line. . <br /> LEACHING LINE No. of lines ............:. ........ Length of each line..........!. ...... Total Length ........... .. <br /> 'D' Box .. .f. .. T Fiber Materia -1 th Fi Material .....�..� .................. <br /> Ytm � p � C�i <br /> - , Distance to nearest, Well . ...... Foundation . ......... Property Line ..w3 �....... <br /> SEEPAGE PIT [ j Depth .................... Diameter ................ Number ............................ Rock Filled Yes Q No <br /> WaterTable Depth ................................................Rock Size ................................ <br /> 40 <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Lkw ................... <br /> REPAIR/ADDITION(Prov. Sanitation Permit tli .........................I.................. two ............................... <br /> ...j <br /> SepticTank (Specify Requirements) ......................................... ......................................».................................................... <br /> DisoosolField (Specify Requirements) .................................................................................................................. .............. <br /> . .............................-•---.........................................._.............................._.................................................................................... <br /> . ........................................................................................................_............................................................................................ <br /> (Draw existing and required addition on reverse sib) <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with Sat Joaquin <br /> County Ordinances, State Laves, and Rules and Regulations of the San Joaquin Lead No" Dlshict. Mom* owner K Hcen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is issued, 1 shoes net r ey any person M such manner <br /> as to become bject to 7m",s Com tion laws of California. <br /> S:gned ..................... Owner <br /> ,� <br /> By ..... ............ ... ............... ................................................... Title ....... ............... .......................... <br /> ..... .... ..... . ..... <br /> Of other than owned <br /> FOR DEPARTM T USE ONLY "' <br /> APPLICATION ACCEPTED BY <br /> ..: DATE .,4 72 ' <br /> BUILDING PERMIT ISSUED r:.. Fr... ... ..........DATE....... ............. ......... ...`..:. <br /> ADDITIONAL COMMENTS -. . .••-••-• <br /> .. ..................................... <br /> ... _.............. ............................................. <br /> ........................ ... ., ? � .... . ...... ...................... <br /> .. .. ................ ...................................................... k .... ........... ... ................... <br /> ..... .. ........................ �+°.... ......................... .... ......... ... .... .... ... ............ <br /> Y•s <br /> Final Inspection by ,�z.. .... ...................................Date ...... /_ <br /> EH 13 2h 1-68 Rev. 94 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> •.r <br />