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.FOR OFFICE USE: <br /> FOR 011ic, USE. APPLICATION FOR SANITATION PERMIT <br /> Permit No,. <br /> ------------ ----------------- (Complete in Triplicate) issued <br /> Date --------s-- <br /> ��_:`-:-----= - ------ <br /> ---------- <br /> ---------------------- <br /> This Permit Expires VNea0rom Date issued <br /> ---------- <br /> -------------- <br /> ---------- install the work herein <br /> 14 San Joliquin Local�Heetfh"District for a permit to construct and <br /> Application is hereby made t the � - irl. , with County rd nance No- 549 and existing Rules and Regulations. <br /> described. This application is made in comp iqrkce <br /> of&2-4-1--------CENSUS RACT -------------------------- <br /> JOB ADDRESS/LOCATION --- -- - - --- -- ----- --------- <br /> _4 one <br /> 4_6( _(3T <br /> -------------------- <br /> Owner's Nome -------------- -- S i----------------------------- city ----------------------------------------------------------------- ---------- <br /> -------------------- /47,? <br /> Address --------------------------- --- # <br /> oe�5 ------------- <br /> License V -W47- <br /> ---- Phone <br /> Contractor's Name -- ------------ ------- -- -- - --- ----------- <br /> J1 -Ir ke,E] Commercial �❑Trailer Court ❑ <br /> Installation will serve: <br /> Resident partment Hous <br /> Motell F1 Other <br /> Number of living units:------1'4-1 N 1. 1 bedrooms ----!;-,-Garba.ge Grinder ------------ Lot Size ------- -------------- <br /> ,um6er of bed Private <br /> me i :� <br /> System dind no ------�.3--------------- <br /> "A'6ter Supply: PUblic Syst -j A ❑ <br /> . (,i� I -- ledE] Sandy Loam Clay Loam <br /> Character—of-io-i I to0 depth,of-3m-f-ef-t-, and'El SiltQ Clay EIL-2--i <br /> --�- -Scj <br /> Hardpan ❑ Adob [I Fill Material' I--- 'lf yesi type ------------------ --------- <br /> e <br /> �!�on to wells buildings, etc. must be placed on reverse side.) <br /> (plot plan, showing size of lot, location of system lo,r I VA.1. <br /> 9 1W -if-publicisewer-is,avap e within 200 feet,) <br /> -pit-permitted. <br /> NEW INSTALLATION: (No septic-tAonk-or-seepage t N <br /> 11�) Liquid Dept ------------------- <br /> -------------- <br /> SEPTIC TANK:["] <br /> PACKAGE TREATMENT I I No. Compartmen 5 ------ --------------- <br /> Capacity ------- Material.--------—--------- <br /> Type ------------------ I ---------- Prop. tine -------------=-------- <br /> Distance 40 ealrest 'We'll ------------- ----- Foundation ------------ <br /> J ---- Total Length <br /> LEACHING LINE No. of Line ------ ---------------- Length of each line---------- ---------------------------- <br /> I I Depth Filter material ---------- ----------------------- <br /> j <br /> & I 'pe�Filter er Material ------ ----------- Property Line ------------------------- <br /> S. --------------- ------- <br /> Distance to Weli ----- ----------- ---- Foundation A <br /> J <br /> - <br /> -------- <br /> - <br /> , <br /> ------- ----,16------------------- <br /> I <br /> No <br /> - bameter Number ------- Rock Filledes <br /> Depth -7 �l- - I <br /> Water Tab Dept -- ------- <br /> RockSize <br /> " <br /> .Fou dation --- ---------- Prop. Line .---------------•----- <br /> Distance <br /> -----------------0---- <br /> i staI nce t ne e <br /> - <br /> -e--- I <br /> - <br /> ----- ------------ <br /> # <br /> - <br /> - <br /> Date -- ----(0 <br /> REPAIR/ADDITION(Prunit IohPermit# -- - ------- <br /> Septic Tank (Specify Requirements) -"__=_--""_""------ - C o3I\A iI - ev---- --- -------------:-------------- --- <br /> Ii ---------------- <br /> jDisposal Feld (Specif�J�Reobrements) - -- <br /> - <br /> -------- <br /> ---------------------------------- -------------- - <br /> -------------------------------- <br /> ----------------- <br /> - ------ ----- - ----- <br /> ---------------------------------------------------------------------------------------------- <br /> ---- - ---------------------- ---- --------- <br /> (Draw existing and required addition on reverse side) <br /> Iin accordace with Son Joaquin <br /> I hereby certify that I have prepared this application and that the work will be dne Home owner or licen- <br /> i <br /> s, State Laws, clind Rules and Regulations of the Son Joaquin LocaloHealth District <br /> n <br /> County Ordinance <br /> sed agents signature certifies the fbilowing: person in such manner <br /> 161 Certify that in the 0 performanceo <br /> f the work for which this permit is issued, I shall not employ any <br /> � <br /> as to become subject'to Workman's Compensation laws of California." <br /> owner <br /> Signed --- ------------------ ------- - ------ -- - ------ -------- - A-------------------- <br /> -- -- - --- ----------- ------- <br /> 0 -------------- ------------ <br /> By ---------------- ------- - <br /> I - --- -- -- -------- <br /> (if of e`r a owner) <br /> FORDEPARTMENT USE ONLY <br /> DATE --- ----------':----------•--- <br /> APPLICATION ACCEPTED BY .... .. -- ---- - ------ -----------DATE ------------------------------------------- <br /> BUILDINGPERMIT ISSUED -------------------- ---------------------------------------------------------------------- ------ ------------------------------- <br /> ADDITIONAL COMMENTS --/.._------- -------- <br /> --- --------- <br /> -------------------------------------------- --------------------------- ---- ------------------------------------------------------- ------------------------------------------- <br /> -------------------------- ------- <br /> -------------------------------------------- -- --- ------- ------- --------------------------------------- -------------------------------------- <br /> ------------ <br /> -- --- --- Date <br /> - ------ ------------------------ <br /> Final inspection by: --------- SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F H 9 1-'68 Rev. 5M <br />