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FOR OFFICE USE: APPLICATION -F(5R SANITATION PERMIT a 7 <br /> • <br /> --- <br /> .; E 1 % .. Permit No. --� --------------- <br /> (Complete.i Triplicate) ,/� 7 L <br /> p Date issued __(./ - - - <br /> ` This Permit Ex fres,1 EYear From Date Issued <br /> ork <br /> truct and <br /> e w <br /> it to cons <br /> F�iA' icallon is hereby r adeis° the made compliance� cwi h County tyal tOrdinan a NomS�}9 and ex st g RulestalndthRegulatonsrein <br /> described. This applicationRb l <br /> .�,w /, T', _ _CENSUS TRACT __ --------- <br /> -- <br /> JOB ADDRESS/LOCATION"---- lh, �"� <br /> 1 --- Phone ----- <br /> Owner's Name --.,A-.- - --------- - = <br /> T - Cit <br /> ,Address ------ ----------------------------------------------------------- <br /> ------------------- ----------------------------------- <br /> .-- -------------- Phone ------------------------------ <br /> Contractor's <br /> ------- -------------------- <br /> Contractor's Name ------ L/� G "...... ---------------- --------License <br /> f <br /> Installation will serve: Residence 0 Apartm4nt House❑ Commercial ❑TrailerX W <br /> MotelE] Other -------------------------------------------- <br /> ------------ <br /> ------ ------- - - ------------ ------- � �� <br /> r !s' ! <br /> Number of livingfunits:_______--._ Number,''of bedrooms ______-___.Garbage Grinder ____-_____._ Lot Size private ❑ <br /> - - - - -------------------- <br /> - ------------------------------------ - - -- - <br /> Water Supply: Public System and name ----------------------------"---••---- - - <br /> i Character of soil to a depth of 3 feet: ;r Sand'❑ - Silt 0 Clay ❑ Peat ❑ Sandy Loam Clay Loam ❑ <br /> Hardpan ❑ <br /> Adobe-❑ Fill Material ------------ If Yes.type ---------------------------- C <br /> {PI'ot plan, showing size of lot, Iota{ion of system in relation to wells, <br /> 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 /> TREATMENT [ I SEPTIC tAN Size-------XA�G Liquid Depth -----------------• C <br /> �.�, Cis .T D <br /> PACKAGE <br /> Capacity - - -- .�--- ---' Type - -------- ------- <br /> _ Material-------=------------- o.�Compartments ----------- <br /> Foundation __/ _- "-- --�_-- Prog Lin`. ! <br /> Distance to nearest:,Well - �-- --- '/ <br /> r "1-�---- Length of each line---- - ---- =------ ,Notal Length �� <br /> -------- <br /> LEACHING LINE [ ) No. of Lines -------�-- - 1-- <br /> / _De th,.Filter Material __ <br /> i ,'D' Box "`=Type Filter Material _1- --------- p <br /> 'f { """-"""" <br /> Property <br /> Line <br /> Distance to nearest- Welh"��----�"----- - -------- Foundation ---- --�----- <br /> I <br /> ----__ - - _ ____ Rock Filled Yes C] No <br /> i❑ <br /> SEEPAGE PIT [ ] �' Depth -------------------- Diameter ---------------- Number <br /> Water Table Depth ---------------.----Rock Size -------------------------------- <br /> --Foundation <br /> -------+---------------------- <br /> t __Foundatio ------ - ----------- Prop. Line ---•--------•------- <br /> Distance to nearest. ,W611 __________________ <br /> ' -------- -- Date ------•----------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit _-------- ------- <br /> --------------- <br /> Septic Tank (Specify Requirements)I___J"_----- - - --------""-"""""""--- <br /> -------------------------- <br /> Disposal Field (Specify Requirements) <br /> ------------------------------------------ --------------- <br /> ------------------------------------------------------------- <br /> (Draw ex-sting and required '-------------------------------- <br /> - ---------- - ------- ------ - <br /> ---- ------ �--�---- ----------------------------- addition an reverse side) <br /> I hereby certify that I have prepared this application and that the work will be dove in accordance with San Joaquin <br /> County Ordinances, State Laws, acid Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the fallowing: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject to W kman's Conipensati.on laws of California." <br /> Signed _-- "_ Owner <br /> - - ----- ------------ -- - ------ --�---A--------------- <br /> -------------- <br /> 1 Title ------------------- - ------------------------- <br /> By <br /> (If other than owner) k <br /> FO EPA1tTMEN USE ONLY <br /> APPLICATION ACCEPTED BY _ -- -- <br /> --------------------- ------ ---------- DATE -- ---- -"�-�-�-�----- -- <br /> r ,, _ r DATE <br /> BUILDING PERMIT ISSUED ---- liil OP%f--T� .L /4T- - C�f// i. <br /> ADDITIONAL COMMENTS -------7 <br /> --------------------------------------------------------------------- <br /> --------------------------------- <br /> -- --------------- <br /> ---------------------------------------------------------------------- ---- - ------ <br /> - <br /> ---------- --- - - <br /> --- Date _ .. <br /> Final Inspection b - - ----------------- --------------- <br /> SAN JOAQUIN OCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />