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FOR OFFICE USE: <br /> APPLICATION, FOR SANITATION PERMIT <br /> - ---------------- - -- - <br /> ---------------- <br /> --------- Permit No-- --------- <br /> --(C6rh0W& in'Trilillicdte)- <br /> Date Issued <br /> -------- ---------------- -----------I This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per'mit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LO TION ------ <br /> �Ili , 61-------e--------S'&-'----—---------------------- --CENSUS TRACT ------- ------------- <br /> Owner's Name C!'CL-r-flas----M.d-_n_c --------------------------------------------------------- -------------------Phone --------- --------•----------------- <br /> ---Address --------------------t;�.V_q�--------et-------M-444,/.---------------------- ...... city ---------------------- <br /> Contractor's Name ------)Q '06, -------------------------------------- ----------License # ___A1V9q_2'�W' --- Phone <br /> Insta.11ation will serve: Residence ['Apartment Housef] Commercial MTrailer Court �E] <br /> IMotel M Other ----------------------------- ' <br /> of living units:--____--I--- Number of bedrooms ---':?:,=--Garbage Grinder _4e�p - Lot Size ----X10P------------------- <br /> Water Supply: Public System and name ----- lPrivate E] <br /> -—------------------------------- <br /> Character of soil to a depth of-3-feet:--4-Sand G --Siltb—,Clay-F_1 Peat[]w—,Sancly--Loam-M_i Clay1oarno <br /> Hardpan ❑ Adobe Fill Materia],V_.�---- If yes, type -----------------------_____ <br /> (.P1,0qplan, showing size of lot, location of system in relation to, wells, buildings, etc. must be placed on reverse side.) <br /> NEWINSTALLATION: (�o septic tank or seepage pit permitted if public sewer is available within fee't,) <br /> PACKAGE TREATMENT f )� SEPTIC TANK{ ] Size------------------------------------------------ Liquid Depth!------------_- <br /> Capacity ---------- -------- Type -------------------- Material-------------.--------- No. Compartments ----------------- <br /> Distance to nearest- Well ------------------------------------Foundation ---------------------- Prop. Line ---------------------- <br /> LEACHING LINE j P40, OT Lines ---- ---- -------------- Length of each line.____.______-_______.______ Totdl Length -t-------------------------- 1\ <br /> 'D' Box --------- - --------------------Depth Filter Material' <br /> Type Filter Material 4- ------------ - ------------------------ <br /> _.-Dtstcince to nearest. Well ------------------------ Founclatioh ------ ------------------ Property Line ----------- ...... <br /> SEEPAGE PIT Depth -------------------- Diameter ---------------- Number ---------------------11----- Rock Filled Yes ❑ No :C <br /> Water Table Depth ------------------------------------------------Rock Si��:, ----'-------------•-------- ! <br /> i Distance <br /> --- ----------------------- <br /> D*tance to nearest: Well ----------------------------------------Foundation ......... Prop. Lihe ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Perertil# -------------------------------------------- Date --------------------*^-----_} <br /> Septic <br /> ------------------- ------ <br /> Septic Tank (Specify Requirements) --------------------------------------- ------ <br /> q -------------------------------------------------- ---------------------------- <br /> Disposal Field (Specify Requirements) .......e, <br /> )1�------------------------ <br /> ----- !77777=----------- (7 <br /> ----------- ----- ----------------------------- ---------------i------- -%- <br /> - ------------------ -------------------------- <br /> (DroW existing and required addition on I`evuse side) <br /> I hereby certify that I have prepared this application and that the work will be done in accoMarite with Son Joaquin <br /> y ';W-T es. an',4- Joaquin Local. District. e owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for whicth this permit is issued, I shall not empi y any person in such manner <br /> as to become subject to Workman's Compensation laws' of California." <br /> Signed ----------------------------- ----------- --- ------------ ---------.- Owner <br /> By - -------------------------- ------ ---------- -------------------k------------------- Title ---- ----- -------------- ------------- <br /> 4.. (If of owner) <br /> A TMENT USE ONLY <br /> APPLICATION ACCEPTED BY,----. 17------------------------------------- ------- DATE ------------- <br /> BUILDING PERMIT ISSUED ------------------ K bATE <br /> ----M - ------------------------------------------------------ ---------------- ------------------ <br /> ADDITIONAL COM TS ----- - -- ------------ ----- - ----- i - <br /> ----------------------------------------------------------- ---------------------- ------------------------- <br /> -------------- <br /> ------------ ------------- ---------------------------------------------------------------- I-------------------I-------------------------- <br /> ----------------------- ---------------------------------------------------------------------------------- ---- -------------------------------------------------------- -------------------------- <br /> ---------- <br /> - - ---- -------- <br /> 4 ------------ <br /> ------------------------------------------I — --- ----------- - - - ------------------- -------------------------------------- ------- --- ---- <br /> Final Inspection by: Z1 A <br /> ------------ - V-- --- --------- --------------------- a <br /> ------------ 26N---LOCAL JPA IN LOCAL HEALTH DISTRICT <br /> E. H. 1-'68 Rev. 5M <br />