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Mm Urr1Vut Wtl <br /> APPLICATION ICOR SANITATION PERMIT 7 7_ zvs 3 <br /> ........Y.. ......:............................... (Consplete in TriplicaHl Permit No. ... .. <br /> .......................................................... <br /> ............... ..................... ............. This Permit Expires 1 Year From Date Issued pate issued 7J <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application Is made In compliance with County Ordinance No. 544 and existing Rules and Regutationsr <br /> JOB ADDRESS/LOCATI _ .�..:lti ..... 't '... -*mac 'f ........................CENSUS TRACT .......................... <br /> Owner's Name . ... .. .......................... .................. .,.....................................Phone <br /> Address . [P �4.�.,- ... ....... . ..... . . . <br /> �- . ._ ......................City ......................*-*--^ <br /> . <br /> Contractor's Name ..L�-► .. .......................Llcense #_5 _. Phone _ <br /> Installation <br /> will servet Residence WKP-'artment House)"] Commercial oTroller Court O <br /> Motel❑Other...........................---------........ <br /> Number of living units:............ Number of bedrooms .......Garbage Grinder ............ Lot Size ...............-.-... ...................... <br /> Water Supply, Public System and name ---------------------......-._..................----..............................................Private <br /> Character of soil to o depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe Q fill Materlal ....__.--if yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,l <br /> PACKAGE TREATMENT ( ] SEPTIC TA i Size__ .-. - Liquid Depth .... r <br /> Capacity 1. - 'hype --_jC-��.�.'.�.�.�..'..�.�Material...................... No. Compartments ..dry-.-............. <br /> N <br /> ' Distance to nearest: Well <br /> .foundation./}d___ <br /> --------------- Prop. Line <br /> LEACHING LINE { j No. of Lines ..d5................... Length of each llne.•.72?... ................. Totdl Length .............� <br /> 'D' Box J........ Type Filter Material .......Depth Filter Material2-4-*./................................... <br /> Distance <br /> • Distance to nearestt Well ....................... Foundation ........................ Property Line .........................0i <br /> SEEPAGE PIT Depth ---------------- - Diameter ................ Number- —........................... Rock Filled Yes ❑ No Q <br /> Water Table Depth ........................................:........Rock•$IzB ................................ <br /> Distance to nearest: Well ..............................:..:......Foundation .................... ..Prop. Line ...................... <br /> .M. <br /> REPAIR/ADDITION(Prey. Sanitation Permit ............................................ Date ............................------I l' <br /> SepticTank (Specify Requirementsl ................................j.......................................................--•--•............,.. ..........._................ <br /> Disposal Field (Specify Requirements) ...................................................................:.......Y..._.................................................... <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 In.accordance with Sas► J"quin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or ilcen• <br /> sed agents signature certifies the following- <br /> "I certify that In the performance of the work for which this permit Is issued, 1 shall not employ any person In such manner <br /> as to becom sub act to Workman's Co pensallon laws of California." <br /> Signed .... • - ...... . ............................................... Owner <br /> ............................ Title ---.................................:................................... <br /> llf other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... .. ............ DATE .. <br /> BUILDINGPERMIT ISSUED ....................... .......................................................------- .........:....:.--DATE ----_...._._M. ...,.....-............... <br /> ADDITIONALCOMMENTS .......................................................-----•••............................................................ ......--•-----..- ......... <br /> -•--- ..... . . <br /> ............-.....................•-------.-----------.--•.... ...... <br /> FinaIn-Is,pection by: ......----.. ...........................Date .... ;. ..r. -fir <br /> EH 13 2h 1'68 ROY• 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3H <br />