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ZIL y e- <br /> JOR (IFFICE USE. <br /> - <br /> APPLICATION FOR SANITATION PERMIT <br /> ...... -------- ........._..._.. Permit No. <br /> {Complete in Triplicate) <br />.......... ......... ................................... % Date I S�e ..... <br /> This Permit Expires I Year From Dole Issued Issued 2F <br /> ......................I — <br /> -S'. -rlgAe k.1 &'Vo Z-90 _3 2__ <br /> Application is hereby ;;Jde to the Son 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/LOCATI N -f CENSUS TRACT <br /> --------- ----------- ...........Phone <br /> Owner's Name . ... . ............ <br /> Address ._ 04 ...................................... ........ <br /> . ...................... <br /> License # Phone <br /> Contractor's Nome . <br /> Installation will serve: R sidence Apartment House I-] Commercial ElTraller Court 0 <br /> Motel [3 Other ............................................' d, <br /> Number of living units:---f Number of bedrooms __3....Garbage Grinder -.-.......... Lot Size ...41?6Z__�_ ................. <br /> Water Supply: Public System and name ............................. ......................................... ...._---------_---------.-.........Private [R <br /> Character of soil to a depth of 3 feet. Sand Silt❑ Clay E] 'Peat El Sandy LoamK Clay Loom 0. <br /> Hardpan ❑ Adobe (:1 Fill Material ------------ If yes,type __------------------------ <br /> (PIot plan, showing size of lot, location of system In elation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic.tonk or seep pit F <br /> ,pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK Size.`--- V. .....W_ tKx. Liquid Depth ............... <br /> -440Type ... ................ Material. No. Compartments .......... <br /> Capacity / A� .,k, .1 <br /> U* <br /> ... Prop. Line <br /> istance to nearest: Well ...... ...........__Foundation ... ... ...... <br /> Z V <br /> Length of each Total Length /-/..... <br /> LEACHING LINE fkf No. of Lines ----------- Le line-----15�.. <br /> 'D' Box �Y-44-1__ Type Filter Material -2tka(A...Depth Filter Material .. . ...... ......... ................. <br /> Distance to nearest: Well ...................... . Foundation ......... .............. Property Line ........................ <br /> SEEPAGE PIT Depth .-............ ----- Diarrieter -----_--------- Number ................ .... Rock Filled. Yes ❑ No <br /> ❑ <br /> Water Table Depth ..............-........... ...................Rock Size ........... .............:...... <br /> Distance to nearest: Well.........................................Foundation ...................... Prop..:Line ..................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............. ---------------_------_---- Date ..................................) L <br /> SepticTank {Specify Requirements) ........................... ........ ......................-......................................... ........ ....................... <br /> Disposal Field (Specify Requirements) IVr--:-5-----A10 .... ...... .............. <br /> 00 <br /> L7...................1. -------- X 15 <br /> ------------- ------------------------------------ ................. <br /> ------------------ <br /> �7 --------- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared 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 San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <br /> "I 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 subject to Workman's Compensation laws of California." <br /> Signed ................. .......r--------- Owner <br /> - ------------------- <br /> ------- ....... <br /> 1-1-------------- -Title .............. .................. <br /> By ----- K.--�Y , �21 .?. . <br /> W-e , �,- -W- ,e , <br /> A6. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATIONACCEPTED BY ...... ................. ..............I............................ ......... DATE ........ ......�/... . ............ <br /> BUILDING PERMIT ISSUED .............•----......_..... .....-•----••-•---•--•— . .................................. ....... ......DATE ......... ............. .............. <br /> ADDITIONAL COMMENTS ---_-----_-_---t_.......-•. -1....... <br /> q2A Kg�s�T.f=-.E?:, ij........................................................................................... <br /> ................ ................ ............I..................I....................... <br /> ..................•---......----------••-----•--•-- <br /># x <br /> ............I.....................­................ . ..... <br /> ............. <br /> ..................... ............. ....... . ...... __ - . . .... :.. . . .......... <br /> -------- ....................... ................. <br /> .....................................Date ...... .. ...... .............. <br /> Final Ins <br /> SAN JOAQUIN -LOCAL -HEALTH DISTRICT <br /> E. H.13 24 1-'68 Rev. 5M 71723 A <br />