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�r <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> d Permit No. . .. <br /> (Complete In Trlpilcotel <br /> This Permit Expires 0 Year From Date Issued' Date issued <br /> i <br /> AFp�icotion is hereby made to the San Joaquin Local Health District for a permit to 'construct and Install the work herein <br /> describers.This application is made In compliance with County Ordinance. No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS OCATION �J�G?. �'.... �� / i <br /> /L r�....�. . .......... ... ..... . .. . . .....�:.. ,...,CENSUS TRACT .._......... ........... I <br /> a <br /> . t <br /> � � 1 <br /> ... 7'�l <br /> Owner's Name .....�t/F.� l/ .. -........ .�e'..........T. /� .........'!..............Phone .................................... <br /> � . <br /> Address _. ..�,�E'............................"........... .............."..:..,..,...................City ............................................ 3 • <br /> Contractors Name..I/i{'1'�5..... . I .. ...5..` A ........... ... .......lirense# J Phone <br /> Instulldtinu will servo: Residente i3 Apartment Huse❑ Comnterciaj�rroilet Court 0 <br /> Motel❑Other . . .... .................................. !} <br /> i.. <br /> Number of living unit: Number of bedrooms .. .=:.Garbage Grinder ....::--:x, Lot Size .I:f"a..a.: s.!q................. <br /> Water Supply, Public System Lind name ..............."..............I.....................Private! _� <br /> Character of soil to a depth of 3 feet. Sand 0 Silt❑ Cloy p Pear C- Sandy Loom, Clay Loam❑ <br /> Hardpan❑ Adobe ❑ Fill Material ........:.,.If yes,type............................ a <br /> (Plot plan, shovring size of lot, location of system in relation to wells, buildings, etc. must be pinred on reverse side-1 < 0 <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet.) <br /> PACKAGE TREATMENT { ] SEPTIC TANK Size..f%t'S�X�. f'.`........�.......... liquid Depth .. ----------------- <br /> Capacity �L�� 1 Type '' Materlal W 90*No. Compartments ! .................. <br /> Distance to nearest: Well ......,5` '.. .................:Foundation!./o...;.......... Prop. Line .5' ............. p <br /> LEACHING LINE jaQ No. of Lines ...... length of each line ..... Total Length .....2t: 'r........... ; <br /> I <br /> 'D' Box Type Filter Material Depth FilterF �•Material ../.� .......... <br /> Distance, to nearest: Well ............4........... Foundation .... ... ..f.......... Property Line ........................ . <br /> t <br /> SEEPAGE PIT [ ; Depth Diameter ................ Number ..,..............€'.......... Rock Filled Yes ❑ No <br /> Water -able Depth .. . ....... .................................Rock Size ...l�... ... ............ .... ' <br /> Distance to nearest: Well ........................................Foundation ... ............... Prop, line ...................... Y <br /> REPAIR/A.VVITIOH(Prev. Sanitation Permit# ........ •...................... ..... ..... Date ............R'................ <br /> Septic Tank (Specify Requirements) ......... . ..... ..... .............. .. .....E#.. .. <br /> Disposal Field ISpecify Requirements) <br /> ..................... ........................................................................................ ...` ..... ..... g' <br /> ••.: 4......... .............�.. ........ .... .I•.. .:.:..... ............. ................ # <br /> :a. ...: ..... .. ..... i <br /> (Draw exlsWng and rerluired addition on reverse sidc) { <br /> 1 hwiW "11110hat C have preporod this applieatle" and that tho work will be dilta In at;"; with fan J"quin <br /> Cawrtlr Or nanm, Stats: Laves, and Rules and Rsguhstiona of fhe Sart Joaquin Lwol'!Wealth Dlsttltt.Rome dwnar or hese.- {' <br />. and 4"signature certifies the fallewing: k <br /> "I certify that In the perfermanee of the work for which this peetnit is issued, I shall nit employ any ponies In such manner <br /> as to boom*ivbl io mkman's Camponsatien lava of Califarnla." I° , <br /> signed " <br /> ./. <br /> f..:. ............................................... Owner ? <br /> B ........................ Isle . ik ri ........................... <br /> . I!f other than awner) <br /> "CIN D[PAR7MENT USE OiVLY � <br /> APPLICATION ACCEPTED BY ................ ......... ................,,..,,rr� a [ ��i..l�:... DATE ...I.,10:7.2Lt..:...:_:.......... <br /> BUILDING PERMIT ISSUED........... ...___.. ........................../...X�.....,.... ..........,......_DATE.. ................... .....".....:....... <br /> ADDITIONALCOMMENTS .. ........ .... ................. .................................... ............ ........... . ........................ ..... � <br /> ........................I..,.. ................. .... !............ ........................ ......... � <br /> Fina! Inapedlon by: .................... ��� .... Date ...��;o.l�-�.Q.. I <br /> SAN JOAQUIN LOCAL HEALTH(P) RICT <br /> E. H. 9 1-'68 Rev. SM <br /> is <br /> E •6 y <br /> !Z + M <br />