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BAR OFFICE vim` APPLICATION FOR SANITATION PERM .. <br /> '. Permit No. ..7,7.:�..3.`� . <br /> ............:........... (Cbmplete in Trlpflcate) <br /> . This Permit Explres.1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to constrict acid Install the work "I" <br /> described. This application Is made in compliance with County Ordinance No. 549 and existing flutes and Regulatlonsr <br /> JOB ADDRESS/LOCATf f.�.� .� ...... ...........................CI:NSUs TRACT. . ....... ............. <br /> Phone ., ✓�:"2.................. <br /> Owner's Name ... . .r .... ... .. .................... .............. �. .......... .. <br /> Address `L-� _ �1�.- �. •............................City ..... ........................................:..:.. <br /> Contractor's Name ...4-". ., ..... ..................................................umnse dE .- . ._.._.1�.. .. Phone .2 <br /> Commercial railer Court ] <br /> Installation wit! serve: sidente�partmsnt Housed DT _ <br /> ` k Mote!(]Other............................................ + <br /> Number of living units:............ Number of bedrooms .-.....Garbage Grinder ............ Lot Size ..................................... . <br /> Water Supply% Public System and name ........................... .. .................... ................. .... ........Private. <br /> Character of soil to a depth of-3 feet:_.-.:Sc4W b r•;Sllt C3 �Clay•D Peat D Sandy Loam D day Loam D , <br /> ! Hardison E] Adobe❑ Fill Material:". 'rlf-yes,type............... ........ ... p <br /> (Plot pian, thowing site of lot, location of system In relation to wells, buildings, ate. must be placed on .reverse We.) <br /> NEW INST11lLATIONe (No-septic tank or seepage .pit .permitted if public sewer is available within 200 feet.) � <br /> .. ..: . Size. ..................... Liquid Depth .................. .. <br /> PACKAGE TREATMENT O rSEPTIC TANK{ .....•.. .......---• . <br /> :..:.... .. Material...................... mpartmenta <br /> Distance to nearest, _A .r..........•••---...Foundation .�®�---........ Prop. Lina '--.rr--..-11� <br /> a: ... <br /> .._ Total Length J....'M.l............. <br /> . <br /> LEACHING'LINE 1( j No. of Lines •-- ................. Length :kfeo;chl ne.... ...............: �� <br /> 'D` ,Sox .�_ Type Filter Material ....Depth Filter Material ................................ <br /> c w <br /> -Distance to nearest: Well ._..------•-_......._ . Foundation ................... Property 'Line ......:......... <br /> .. <br /> • - N <br /> SEEPAGE PIT ., ( j Depth . Diameter ............ Number .......... <br /> Rock Filled Yes'D o <br />} wager ai,le Depth ........... .......Rock Size .............................. <br /> Dia#artce to nearestr Well ....................................Foundation .................... Prop. Line ....... .. .4.-- <br /> REPAIR/ADDITION(Prov. Sanitation Permit .� ....................................... Date .................................. <br /> Septic Tank-.jSpeclfy Requirements! .................. _.................................................. ........ ..... :............ <br /> Disposal Field (Specify .-Requirements) ..-..----. ...................... .......---•--..._.......---..................................... ........I.......... .- <br /> y 3 "° 7 <br /> ..............z.._--•............_._......... ....._............ ....... ............... .... <br /> r. -•-'___.. ..'. ...... ,......rr•`Y-r---.T•s....................................._ .......................... - .............. ....................................... <br /> .................... .......... <br /> (Draw existing and required addition an reverse side) <br /> I hereby certify that l Boge prepared this application and that the work will he done In accordance wills Sen 'JoagOf" <br /> County Ordinances, State Laws, and Rules and Regulations of the.'Son Joaquin local Health District. Home owner or Been• <br /> ;:. sed agents signature Certifies the following: <br /> °'I certify that in the performance of the work far which.this permWis issued,_I shall not employ any person In *nch manner <br /> as to betomeisubject to Workman's Corn ens itl6h lbws-of-California. <br /> r L. <br /> ✓ ....... ........... Owner._ .. <br /> ---....... 3itle ---......------...... ...... .................... <br /> 8y .... ............... ................... ......._... ..............- . ......_ <br /> (lf.a#her,than owner} -yA. <br /> ti <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ............DATE. ' ` j ...... . <br /> BUILDING PERMIT ISSUED ................................................................................DAT'E ......................:............: r <br /> .............. <br /> ADDITIONAL-COMMENTS <br /> ............. ...:.... / ......_':...... ............:........ .... .................... :'.... <br /> l ti nb ........L... -_ .._. .................... .Date ..,. •" /./ <br /> Final Inspec o y: . .,� . <br /> EH 13 2h 1-bfl Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/A 31"l <br />