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FOR OFFICE USE: <br /> .......................................... <br /> APPLICATION FOR SANITATION PERMIT................. <br /> • Permit No. <br /> ;Pompfeto In Ttiplltate) <br /> .................*......I............. <br /> .............I...........;............. This Permit 1xp!5!S I Your From Date Issued Doti.Issued/j* <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 l is made in compliance with County Ordinance No. 549 and existing Rules and Regulations- <br /> ji <br /> .JOB ADDRESS/LOCATION ........ ........................CENSUS TRACT .......................... <br /> Owner,s Name r" IFY . ............ <br /> ...... ....... ...........*........ .......Phone.... <br /> Address g. _1-0 <br /> J­N.�.Q.n...... city ......................... <br /> Contractor's Name Vti..... ................................License # X6.7.H,%Z.. Phone T0:75At-.U. <br /> Installation will serve: Residence 1%Apartment House 0 Commercial OTraller Court 0 <br /> Motel [j Other....... .............................. ...... <br /> Number of living units:_.. Number of bedrooms ...Garbage Grinder N.Op... Lot Size .............................. ............. <br /> Water Supply: Public System' and name ---------__1................................ .............................................Private <br /> Character of soil to a depthof 3-feet: Sando Silt(] Clay 0 Peat[:] Sandy Loam a Clay Loam lg <br /> Hardpan Adobe 0 Fill M6terial ............ If yes,type ............... ............ <br /> (Plot plan, showing size of lot,'-Iocotion of system In relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION:, (No septic tank or seepage pit permitted If public sewer is available within 200 feet,} <br /> PACKAGE TREATMENT SEPTIC TANK f I P" Size..../.2_10_0...I_6L...... Liquid Depth .6.:FT.............. <br /> Capacity LZQ49__�Al Type -----�AIT---- Materialtavitsv*—e- No. Compartments 2................ <br /> Distance to nearest; Well _�:.tZSfP7 ...............Foundation ../..72............ Prop. Line ..... <br /> LEACHING LINE No of of Lines .... ............ "Length of each line... ....... Total Length ?o.-"T............. <br /> 00 <br /> 'DIBox Type Filter-Mate iol P. ... .eKl) <br /> ai <br /> pth'Fifter Material'nearest:'We Distance t .... :qI7.............0 , <br /> 4 <br /> to nearest: _ +..r <br /> r <br /> ../-U............ Foundation Property'Llne. ..0..... .. ..... <br /> -I-qf_r.. Diameter # <br /> .....,--Depth Way/6- Number .......... Roc V Filled Yes IS No 0 <br /> Water Table Depth ........ .......................................Rock Size ...... <br /> Dista' nce to,nearest. Well"/4/W_A:!r................Foundation S77PSr. ... Prop. Line 73?4. <br /> REPAIR/ADDITION(Prev.,So ni'if6t!on,Permit# ...... ------------------------------------- Date A017-1,_,�4............I <br /> I Septit Tank (Specify Req6irements) --------- ......­_.�,............. .................... .............................. ................... <br /> ............. <br /> DisposalField (Specify Requiremeritsi .......... ................... .............. .................. ...................................................................... <br /> ------------------------- -------- -------- --------------- ----------------- <br /> 7 ....................................­........................................1-------I...... <br /> ------------------- ------------------------------------------------------------------------------------------ <br /> -----------1--..........................................I..................... ........ <br /> ---`---(DraW-&isting and required addition on reverse side) <br /> I hereby .xertify that I havWorepared this application and that the work will be done In accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local HeaI&DIshict. Rome owner or 111cen- <br /> sagents signature certifies the following: <br /> -.[-certify that in the performance of the work for which this permit is Issued, I shall not employ any person In such manner <br /> as: to become sub toat tq��Workman's Compensation laws of California." <br /> Signed------- ------ --- • -------I------------­---------- Owner <br /> • <br /> By ---- --------------------- --------:----------------- -------------------------------------------- Title --------- ----- - - ..................... .............................. <br /> (if other than O"wnerl <br /> _ef5?__.11FOR AART 14ENT :USEONLY ► <br /> APPLICATION ACCEPTED BY DATE <br /> .,.�9 Z_ <br /> --------- -----------L7---------- <br /> BUILDING PERMIT ISSUED ----------------- ------- .........................DATE ....................................... <br /> ADDITIONAL COMMENTS --------------------------------.•--••--•-•------------------••* W <br /> ----------- -------------------­----- -------------------- --------------- -------------------------------------------------____........... --------------- <br /> .............. ........... ---------------------- <br /> ---­--------- ------------ ------------- .................. .................................................... <br /> ---------- -----------­--------------- <br /> .. .. .. ..... • ------ ----------- <br /> Final Inspection by: ... <br /> ..................................... ----------Date <br /> 8/7h 3M <br /> EH 13 24 1-68 II v. ` <_ 9" <br /> SA �' JOACUINL LOCAL HEALTH DISTRICT <br />