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SANITATION PERMIT <br /> FOR OFFICE USE,. Permit No.. <br /> APPLICAyi^-N�I-FOR .4 <br /> 1C <br /> FOR OFF <br /> 2 L> <br /> 7 US, <br /> ICE <br /> --------- )Complete Triplicate) 7v <br /> D---------- ompi <br /> Date Issued - --------- <br /> ------------------------- <br /> This Permit Expires 1 Year From Date issued <br /> ---------- <br /> ------------------------- install the work here-in <br /> construct and <br /> ------------ ing Rules and Regulations: <br /> n is hereby mode to the Son Joaquin Local Health District fora <br /> permit to <br /> ce with County Ordinance No. 549 and exist <br /> atio is made in camp ----------- <br /> "pp <br /> iescr�icbecl. This application ----- --CENSUS TRACT --------------- <br /> 4 - <br /> OB ADDRESS/LOCATION -------q- --------- <br /> b Phone ------------------------------------ <br /> V <br /> .Dwner.s Name ------ <br /> y #r -------- <br /> ___ . <br /> ---------------- Cit r�,O/Phone ---------------------- <br /> -------- <br /> --------------------------------------------- <br /> - <br /> \ddress ----- . .......................--=--------License <br /> onTrClctor'sll�_f__- _rjo , Commercial railer Court `0 <br /> pcirtment House,0 COmmerc )l <br /> ► ristallation will serve: Residence R A 11 1 <br /> ----- - --------- <br /> Motel E]other ---------------G-a-rbage--G-r------i n d e-r Lot Size 0_ -/------------- <br /> er of living units:,_u�---- Number of bedrooms --rTr7 I -------------------------Private <br /> ,Qumb ----- ---------I--------- ------------- <br /> ­ ----- --- --- <br /> 'Nater Supply: Public System and name --------------------------------Clay E]-----Pept Sandy Loam E] Clay Loam 0 <br /> 4 7,haracter of soil to a.depth of 3 feet: Sand'01—Silt 0--- ----------------- <br /> I -------- if yes, type -----i------ <br /> Fill Materia ----- <br /> Hardpon-t, Adobe X — <br /> t`', e side.) <br /> lo'�Iclings,-etc. must beolaced on revers <br /> wing size-Of-10t,­loc tion-of1 system-in-relation-to,wbilsil ul 200 feet,)plan, showing -1 <br /> septic tank or seepage pit permitted if pvblic sewer is available wit n <br /> N- (No sept e - - Depth ------------------- --- <br /> Size I - <br /> 4W INSTALLATIO 4 ------------ Liquid <br /> SEPTIC TANK <br /> No, Compartments <br /> PACKAGE TREATMENT Material efIMI <br /> poclty/,;�Ip TypejO-V;lk Prop. Line ---- <br /> Ik Co ation ------------ <br /> I We( --------------------Found <br /> V0 'Distance to nearest: line ---- ------ Total Length ----------- <br /> of Lines ------/---------------- Length of each <br /> I J� ` .............. <br /> LEACHING LINE NO, h.Filter Material -------- <br /> ■ <br /> ----- Dept <br /> D' Box /f/,e?;:1,Xype,Fiiter.Material --------- <br /> - - r -' Foundation ----------- Property tine., <br /> e topearest: Well ---------- . I <br /> Distance '09 ,',P& k •-- Rock Filled Yeso No <br /> /'Number __/------------- ------- <br /> '0V <br /> epth - ---------- Diameter ----- <br /> SEEPAGE PIT D :;If --Rock Size ----------- <br /> --------------- I _ / <br /> 7, <br /> --- ------------ <br /> Water Table_Depth <br /> ___ ---Foundation --- ------- Prop. Lin <br /> Distance to nearest. Wells___,* ---------- <br /> 0, <br /> I - <br /> E Date ----------------------------------) <br /> REPAIR/ADDITION(Prev, Sanitation Permit# -------------------------- I ----------- -------------- ------------------------------------------------ <br /> -- --------- <br /> ------------------------- <br /> - <br /> Septic Tank (Specify Requirements) ----- ---------- <br /> !L ------------------------------------------------------ <br /> Vl - ---- ------- <br /> Disposal field (Specify �equiremenfil - --- --------------- I------------------- <br /> -------------- <br /> - - <br /> -- ---- --------- . -A-. -- ---------- <br /> -------------------------------I------ - <br /> - ------- <br /> t - I--- ------------------------------------------------- <br /> ----- ---- <br /> (------ ----------- --------- Draw eki;tf6g andrequired addition on reverse side) orclance wilth ian Joaquin <br /> e ow6r or licen- <br /> "I have prepared this application!and that the work will beid�ne in acc <br /> I hereby certify that,A, H and-tegula"tions of the kpn Joaquin Local District. HOm <br /> State Laws, and Rules I <br /> County ordinances, q --—I tv in such manner <br /> sed agents signature certifies the following: /�7 A <br /> is issued, I shall Mot employ any person <br /> "I certify that in the performance of the work for which this peririit, I,./ <br /> i----- --- # F J <br /> as to become subject to Workman's Coi;pensation laws <br /> Owner <br /> of California." <br /> Signed---------------- --------------- -------------- itle ------ ------- <br /> By ------------------------------------- <br /> (if other th caner) FOR DEPARTMENT.*USE ONLY DATE --- ----------- -------- <br /> APPLICATION ACCEPTED BY -- ----- -------------------- -- ------------------------------------------------------- <br /> I DATE <br /> BUILDING PERMIT ISSUED ---------- ------ ----------------------------------------i ----- <br /> -------------------------------------------------------------- ----------- <br /> ------------- ----------- ---------------------------- <br /> ADDITIONALCOMMENTS ------------------------ --------------------------- ---IL---------------------------------------------------------------------------- -----------------10--- ------------------------------------ --------------------------------------------------------------------------------- <br /> x----------------------- ---- --------------- <br /> 7 ---- <br /> --- - --- ---- Date ---- -- -- ------- ----- <br /> --------------- -------------- --- ------- ------------- <br /> ------ <br /> ----------- ------------------------ <br /> ------ ---------------- --------------- --------------------------- <br /> Final Inspection by: ------ <br /> SAN JC/AQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />