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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br />._........+�.---. --- --------------------------- Permit No.�/ <br /> (Complete In Tri e) <br /> - plicat <br /> ....�._ 4..... ._�.._.: ._.. .......�.._._.. . <br />......................................................... This Permit Expires 1 Year from Date Issued <br /> Date Issued ...�.` ...: � <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and Install the work herein i <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> 4 <br /> .JOB ADDRESS/LOCATION .................... ......................CENSUS TRACT Aq!a!Ilpp........... <br /> Y�artin Heli ...............Phone 362094 <br /> Owner's Name . ....�.........................•------•------•--•--------..._..............-----.._......,...................... ...---..........__ <br /> Address ..Same. ...... .... .... ....... --•- ............. ..----------:......,....:..........,.. City ........................-,............................................ <br /> ...... <br /> Contractor's Name er. Phone683933 <br /> CSetATank- S.._._......._._...........--•- License0 <br /> ......... <br /> Installation will serve: Residence®Apartment House] Commercial [)Trailer Court 0 <br /> F Motel ❑Other ............................................ <br /> Number of living units:--.-----..__ Number of bedrooms ............Garbage Grinder ............ Lot Size ............................................'111-S <br /> Water Supply: Public System and name ............................. ................... - -.._............:......._..................Private ❑ <br /> Character of soil to a depth of 3 feet: Sand n.,. _Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ ' <br /> Hardpan ❑ Adobe❑ Fill Material ............if yes,type ..............._.............- <br /> {Plot plan, showing size of lot, iocation of system;in.relation to wells, 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 /> PACKAGE TREATMENT [ ] SEPTIC TANK f 3 Size...................................._............ Liquid Depth .......................... c <br /> Capacity . Type .... Material... :..:............. No. Compartments <br /> Distance. to nearest- Well .....:......:..Foundation .....................- Prop. Line <br /> LEACHING LINE [ ] No. of tines ................I------- length of>each line....---------------.-------- Total length ............................ <br /> 'D' Box ----- ----- Type :Filter Material .......`............Depth .Filter Material ....................................... <br /> ...._ <br /> v- <br /> Distance to nearest; Well .........................Founda#ions .._. 4-R_.,...�..:.,.,__ Property Line ........................ <br /> �` ! Number V-'...'_-:-- -•---...... Rock'`Filled Yes No <br /> SEEPAGE PIT-- [-j'`� ` Depth ---.-::.---.:_�Diamet6 --------------- ❑ <br /> Water Table Depth --•..............................• - <br /> --------..--Rock Size --- ------- .................... <br /> a Distance to nearest: Well ---•.._..--- -Foundation ------ Prop. Line .....:................ <br /> ..........--- <br /> REPAIR/ADDITION[Prev. Sanitation Permit#. ....... :-------------------_---- Date ............................... <br /> Septic Tank (Specify Requirements) ---- -- ---------------------------------•-----•-----..._...----•-•----.................---•---------_... <br /> t tt n n n <br /> Disposal- Field (Specify Requirements) Q. __. ._._._ --1ine,.to _D - Box_ and t en.......................... <br /> - - _ <br /> _. 1d�epad20' long - <br /> ....... _..h <br /> ------------- ------ - - • ---•-----------. :--- <br /> .. <br /> i <br /> (Draw existing and required addition on reverse side) I <br /> k I -hereby certify that l 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 Son Joaquin Local Health,District. Homs 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_'arson in such manner <br /> as to bec4suble Work s Compensation laws of CalifSigned ---- `' ----• :---- Owner----- -- --------------------------- <br /> BY T" Title Owner.-..G"- -.. _Sep#q, dank Ser. <br /> .... .__.er than owner( s--� <br /> F R DEPARTMENT .USE ONLY <br /> APPLICATION ACCEPTED BY _- :. ---:•------•--------- --------- _ - DATE .d ..::.:.._- ..-.._.. <br /> I3UiLDINGPERMIT"155ElED ----------------=------------- - -•-------------•----...................................----------------DATE ................................. <br /> ADDITIONALCOMMENTS ----------------_-------.------- ._... .......................................,........................ ............................................ <br /> ------------------------.---------------•-----------•-----------•------------------ ------...._._. ....----_.._ ...... --._..._.--........ .......... <br /> -- -•------------•----------------------- ----------•--- - ------------------------- ---•---------- ---------. ............. -_---- .......... <br /> 4 J <br /> ' Final inspection by_-_­-,_,_.­._.,_.,------'- - --- -------------•--.:...........---•-�•-------••--•.._.......---- --._... .---.. <br /> b ....... .. :..... --_... <br /> Ell 13 24 1-69 Rev. S N JOAQUIN LOCA! HEALTH DISTRICT ` � 8/74 3M <br /> - <br />