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APPLICATION FOR SANITATION PERMIT � <br /> ........ (Complete In Triplicate) Permit No. .7....:.f�. .. f <br /> ..................................... <br />..... . . ..................... . ,This Permit Expires t Year from Date Issued Dab issued :L i :.17K ' <br /> 1 <br /> Application is hereby evade 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. 549 and existing Rules and Reguldtlonst <br /> jOB ADDRESS/LOCATION ..... .,f L.! .....1. CENSUS TRACT ......... <br /> . ..:. <br /> Owner's Name . .. jam' ��- .....: ..........RST ....... ..... .P/hone ........ ' <br /> Address ....................�Cily:.lL i.._. �.............. . .......... <br /> Contractor's-Nartie , c. ..:-•..........................................License 21.74.��. 2-- Phone <br /> Installation will serve: �e=e artment House Commercial roller Court <br /> fl o <br /> �a <br /> Mate)❑Other � � . <br /> Number of living units:............ Number of bedrooms _'2-----Garbage Grinder............. Let Size .................................. <br /> WaterSupply: Public System and name ...................................__...................---------_..........................................Private I <br /> Character of soil to a depth of 3 feet: Sand 0 Slit❑ Clay ❑ Peat❑ Sandy Loam C) Clay Loam [❑ <br /> Hardpan❑ Adobe❑ FII)Material ............ If yes,type............................ � . <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc.. must be placed on reverie' side.) <br /> NEW INSTALLATIONa (No septic tank or seepage pit permitted if public sewer is available within 204 feet,) ' <br /> PACKAGE TREATMENT [ ] SEPTIC TANK I ] Size....... ..._... Liquid Depth ........................... <br /> Capacity pe ... ;.-xfMaterlal...................... No. Compartments ...:::F. ... <br /> Distance to nearest: Well � ... Prop. Line <br /> r ......._._.Foundation <br /> LEACHING LINE [ ] No. of Lines ----.�............... Length of each llne..�� .................. Total Length .l ez f..........." <br /> 'D' Box I....... Type Filter Material RAOX...Depth filter Material ...................::.'...... <br /> • Distance to nearest: Well Foundation ........................ Property Line ...................»... <br /> SEEPAGE-,PiT"j-j�~~ Depth -------------------- Diameter ................ Number .........I.................. Rock Filled Yea ❑ No Q <br /> I <br /> i <br /> Watery. Table Depth ----•-------••................:.......•--....._.Rock Size .•------._.....---....-•---••-- : <br /> Distante�to eanost: Well ....Foundation ...... Prop. Line I I <br /> .✓ 4. \��1 ��._..+.. s Y <br /> )REPAIR/ADDITION(Prov. Sanitation PBr-10 -:.•------------------ - Date . <br /> Septic Tank {Specify Requirements) ..... `............................................................-- . ..................••......�...... _ .........._.... � ........ <br /> DisposalField (S�Xify Requirements) l ......................................................................•--•--•-•-------.................... .. ...... <br /> ............................. -- ---•---•---•--•••-...... I'r' .... .................._..............----•..-...-....................................................._.... . ........... <br /> .............................. .................. -...z�'.:.�,4,: ._^- -�_==- ........._..........._ ............. <br /> (Draw existing and required addition on reverse side) t �, <br /> I hereby certify that I have prepared this''ap1pp lcationand`th`cit-Wo work--Wi11"be done In actor ci with S Joaquin # <br /> County Ordinances, 'State laws, and Rules and Regulations of the San Joaquin Local Health District. Norse owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify tha�fhe performance of the work for which this permit is issued, i shall not employ any person In such,manner <br /> as to beco a subiait�to W rkman's Compensation laws of California. <br /> �!�o <br /> Signed ... Owner <br /> 8y .................-....................................................-.- . title ........................... <br /> x <br /> (if other than owner) r <br /> i <br /> FOR DEPARTMENT US!$,ONLY <br /> � ': �-.�, <br /> APPLICATION ACCEPTED 8Y . .. ......--. ... . ......:......... .. DATE ......' <br /> i <br /> BUILDINGPERMIT ISSUED .....................: ...............................................--....................--.......DATE ......................................... <br /> ADDITIONAL COMMENTS .............................................:........................... <br /> . <br /> ..............................................................................................................................................................--....-•----I......_...--.•-•--.... pf <br /> --•...........................................................................................-•--•••-----. k <br /> .... ............................................. .....--•----- <br /> 4 <br /> Final Inspection by: -- ....... .............--............ . ._•---........------ <br /> EH 13 21J 1-6$ v• SAN tOAQUiN LOCAL HEALTH DISTRICT 8/74 31H I <br /> - �1-4 <br />