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FOR OFFICE USE: _ <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete In Tefpfiratel Permit No. /� <br /> Date Issued . <br /> This Reernit Expires t Year From Date Issued ............... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work hereto <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION SV"g 7 - CI: 5 <br /> ....................................... <br /> Owner's Name <br /> 1 NSU TRACT <br /> t on <br /> �' . �. : . Ph e j:3/..�0, fu <br /> Address ---.. .. .... 4.?.: -......-�-........ .............................. City ..a7. c rQ1c/................ ..... ................ <br /> ; <br /> Contractor's Name -^ <br /> �l -�' �l-J�R_e 21, �G�...¢ 1H-� r�l�—..license .5'5�3.�F-3... Phone Ef :E: a2...... <br /> Installation will serve: Residence A artment House � ;Commercial y <br /> d P �] ❑Trailer Court E) , <br /> Motel Q Other--- --------- ------•-- <br /> Number of living units--,/---- Number of bedrooms �--..Garbage Grinder Lotze ��. ........., <br /> z <br /> Water Supply: Public System and name ................ <br /> ........ ..... ........................................... <br /> .....:.......P <br /> rivate k <br /> Character of soil to a depth of 3 feet: Sand bSilt <br /> CI qClay'p Peat❑ Sandy Loam 0 Clay Loam, <br /> Hardpan❑� Adobe j9 FIII Material ...... I <br /> ...... #e e ! <br /> .,� f y 4,type..;........... ........... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc imust be placed on reverse side.) <br /> NEW INSTALLATION- (No septic tank or seepage pif,permitted if public-`sewer is available within 200 feet,l <br /> t <br /> . 1 <br /> PACKAGE TREATMENT [ ] SEPTIC TANlCf j 4'isize......:............. ..............._'_._._..... Liquid Depth <br /> Capacity ------_ Tyle ----- ----- <br /> .... Na. Compartments ..:.......... <br /> p ----...-----• •------- Material..--•-----------•• .........� <br /> f , ,� <br /> Distance,to nearest: Well ...................................Foundation......_.._.._.. .... Pr p ine <br /> LEACHING LINE ( j No. of Lei1 th-Lines ................. •--- g of each Tinai <br /> .... ............... ... Total length <br /> 'Q' Box .....-------- Type. Filter N aftericil -- De th Filter Material . <br /> - P <br /> Distance to nearest. Welt <br /> FoundatV Property tine ........................ <br /> SEEPAGE PIT { 1 Depth ......i............. Diameter .--...-----�- Number --------.-----",.......... Rock Filled Yes No 0 <br /> Water I I � � k I � .1' <br /> Table Depth •---• •-••...... ........:...A-..Rock Size._.............................- rb <br /> Distance to�nearest: Well, Foundation...Foundation ................. .. Prop. Lina .--•-•--............. A <br /> REPAIR/ WDITION(Prev. SanitationlPermit ..........,._-_-..- � <br /> .V+ <br /> s <br /> ' <br /> Septic Tank (Specify Requirements). <br /> S <br /> . <br /> Disposal-F.idi� Specify-Requirements) ----•- r ---- -- ----- ..................-------......------------ �...............: <br /> A--6 0- �-. <br /> --------------------------------------- _..._....-•--_-.-..._..---..-....-..•....._-._............................................... <br /> (Draw existing and required addition on revers_sidel <br /> 1 hereby certify that I have prepared this I application .and that the weirk,wlll be done In accordance with Saes Joaquin <br /> County Ordinances, State Laws, and Rules and Regulptidns of the Save Je`gine' Local Health;Diitrict. Home owner or licen- <br /> sed agents signature certifies the following: <br /> 'r <br /> "I certify that in the performance of the work_fnr whlch this permit is issued, 1 shall not employ any person is such manner <br /> as to become subject to Workman's Compensation laws of California ". <br /> Signed ... ..........rncc CvrFEr " <br /> By ..........----------------------------.----------------------------- <br /> . .- <br /> (If other than owner! ............ <br /> l FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---.- ..` DATE -.- .. .--.- .. <br /> BUILDING PERMIT ISSUED _-................... ,... -----..-,.,7-�i <br /> .................. .......- ...:----- ----------------------- -----DATE -----------------------------------....-- <br /> ADDITIONAL COMMENTS .. ....-----...........•--•-•--•------------------------""`�-------•---- ...................... ..................... <br /> ...........-----------------------......•--•----- j1 0- ,../ 0 : l <br /> _ . <br /> --------------- •------•----•---•-•-•--------. ....- _ :.. <br /> -------- __ <br /> EH <br /> " T <br /> Final inspection by: -•----••------------------- -------- --- .......----....-..----------Date -...-. `''.- � �•• ` <br /> J 3 2 �'� SAN JOAQUIN LOCAs 4EALTH DISTRICT <br /> B/7h 3M <br />