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i <br /> FOIL OFFICE USE: <br /> APPLICATION FOR SANITATION I'EAMIT <br /> N (Complete in Triplicate) Permit No: <br /> Date Issued . <br />.... .. ........ .:....:...........:................ This Permit Explrer 1 Year From Dale lssued � . <br /> Application it Heie't y' made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> 'described: This dpplitrifion Is made in compliance with County Ordinance N0549 and existing Rules and Regulritlonsr <br /> } <br /> fCB ADDRESS%LOGAYIiv ... .3 � ....,.C ►.�.V _:..I�..✓... .............:........... <br /> . .... ............. <br /> _ _ _-CENSUS TRACT <br /> Owner's Name ._...: - -•-••�! --- ._, �. _.. _w...�.�.. <br /> Address ,z�r9M .._..._ .......................... :...... City :... irpaN._... <br /> Contractor's Name __4I .r.._f� ?� o/�!x .:,c...............................SN ° ::....license # I. 6`S"�('.. 'Phone <br /> ... <br /> Iitstdllotioit will writes Residence®Apartment House t3 Commercial pTtaller Court ❑• <br /> Motel b Other -� <br /> Numpber f )iving unitsi..,.1..... Number of bedrooms ...Y......,Gorbage Grinders.._ lot 51ze :r ..............................>` S <br /> Water SuOpiy: Publik System and fidme ...........:.... <br /> :.... <br /> Chbrocter of soli to d depth of 9 feet: Sand Silt Ga Peat~b $a Private <br /> ... .. i to <br /> ❑ y ❑ - dy Loam [] Clay Loam [] <br /> Hardpan <br /> Adobe ❑ Fill Material if Veii -typo " <br /> (Plot plan, showing size of lot, location, of system in relation to.wells,_bulldings, etc, must be .placed on reverse side.) <br /> NEW INSTALLATIONrt, IND septic tonk or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT j ] SEPTIC TANK f ] sr:®..: X, X 9 y <br /> 600 ............. liquid Depth ... �............. .6 <br /> Capacity .... .�. ... Type �y� C�+S7" Material..Ca. .� .... No. Compartments ........ ..... F <br /> Distance to nearest: Well ..........- r��................Foundatlon ....�.p �......... Prop. Lino ...1007 <br /> LEACHING LINE No. of Lines . `�-5 ::FT Length of eacFt <br /> 'D' Box ...I........!Type Filter Material . F#Icor Material ... .y.............................. <br /> ....� <br /> Distance to nearest, Well .../od.�. .... Foundation .............. Property Line .....T. ............ <br /> SEEPAGE PIT t j Depth ......:......... Number <br /> ....:......:..::::.. Diameter ...:...:..................:. Rock Filled Yes ❑ No C3 �. <br /> Water Table Depth ...............................................Rock Size ....................... <br /> Distance to nearest, Well ........................................Foundatlon ................. Prop. line <br /> REPAIR/ADDITION(Prey. Sanitotlon'Permit 0 ........................................... .pate .................................. <br /> ........... <br /> . ...........�. <br /> Septic Tank (Specify Requirements) ...... .......:............................................................ .. . ... ........ <br /> Disposal Field ISpecify Requirements)r ..................................................................................................................... <br /> :.................. , <br /> ................................ ............ ..........................................I.......... ................,..........................................,........................ <br /> ...... ....... ........Draw.............................::.......:_::............................:................................I............................ <br /> [ harsh cerci that i have prepared this existing and required addition on reverse alae) <br /> y certify s application and that the work wlll be don* in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven. E <br /> sad agents signature certifies the following: . . <br /> "I certify that in the performance of the work for which this permit is issued, Ishall not employ any person in such manner t <br /> as to become subject to Workman's Compensation laws of Callforrtio," <br /> Signed ......F, An,T h.n^�.y......t...50 ,y.:.....: .....:................ Owner.. .. <br /> By ......... �s �: !1 I <br /> Fes" (i f ........................................ Title ................................ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED SY .. .... . . . ....................... ...., DATE ..... -- s ......:..... <br /> BUILDING PERMIT ISSUED "'"""" "�' " <br /> ADDITIONALCOMMENTS ........................r........................,.................,:......:...............................DATE .. :.................................... <br /> ......................................._............................ --................................ ...'....:...::................................:......... ....... .... <br /> . .............................. <br /> . .... <br /> ........... <br /> . ......... . ........... ......... ...................................................... .....: <br /> ............. .......... t.. � <br /> .....'L�.�.��.. <br /> Final InsP..tion b i ... .. <br /> SAN JOAQUIN �LOCAL HEALTH DISTRICT <br /> E. H. 13 241.'68 Rev. 5M . 7172.3 M <br />