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4 <br /> t <br /> m <br /> FOR OFFICE USE- APPLICATION FnR SANITATION PERMIT <br /> .. <br /> . ... Permit No. ' <br /> (Cortpleto In Triplicate) � . _ � <br /> n y <br /> This Permit Expires 1 Year From Daft Issued Date Issued . <br /> Application is hereby mode to the San Joaquin local Health District for a permit to rt-struct and install the work herein <br /> described. This application i rode ij, amp!lance with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOr,.AT1ON .... ... _7R-0.0,0. CENSUS TRACT .......................... <br /> Phone "x.59..3350 <br /> Owner's Name 70Ht�t....8t:o Thi .�J. .. .S'aN,�.!-�AF,J..................... ....... <br /> Address :. I�, .,.. ao.x. .`�.� ......................................City .............................fi�..... <br /> C.,ntractor's Namr .............License# ........................ Phone ..............................� <br /> " <br /> installation will serve, Residence 0 Apartment House C) Commercial❑Trallor Court fl W <br /> Motel 7 Other. <br /> Number of living units:....1...... Number of bedrooms .........Garbage Grinder .Yfs.. Lot Size <br /> Water Supply, Public System and name .....Q4 f=!.......l.s.3.41T.]E.R.........tA..�.E.t.l.................... ....................Arwate C4 i <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Joann❑ Clay Loam 77 <br /> Hardpan IQ Adobe Q Ftll IVtoterlal_...........If yes.type...4...................... no <br /> (Plot plan, showing size of lot, locntion of system in relation to wells, buildings,.etL mutt be placed on rrwrse d&.l <br /> NEW INSTALLATION: Wo septic tank or seepage pit permitted If public sower17 eevolloble within 200 feet.) <br /> N PACKAGE TREATMENT ( ] SEPTIC TANK ly Size...... .1 0 .. Liquid Depth .... ........... ' <br /> Capacity I. '�4...... Type r c°s Material.. ASS r I rf r: No. CompattmeMs .. ..... .. } <br /> Distance to nearest. Well ........ .�d................Foundation ... ..':....... Prop. ....`... '3 <br /> LEACHING LINT: No. of lines . ....... .I.......... Length of each line......1�..... .......... Total Length . .1. .S�.f.......... i <br /> 3 'D' Box ..... .r: .. T ypv Fitter Material Sr il. e- 160opith Filter Matwial ...........�. .�..........t............. <br /> Distance to nearest, Well .... Foundation ...... ...... Properly Line ...M.:t........... i <br /> SEEPAGE PIT ()- Depth /��?j.... Number :...:..... Rock Fillet! Yes ®' No ❑ <br /> ��.�......... Diameter <br /> Water Table Depth ................./.,.4�1.y.................Rock Size .....J...`.?. L........... �: I <br /> Distance to nearest, Well ........... ..............Foundation Prop. Line ...:76 ..`_...,.. <br /> i <br /> R <br /> E <br /> P <br /> A <br /> I <br /> R/ <br /> A <br /> D <br /> D <br /> I <br /> T <br /> I <br /> O <br /> N <br /> (Prev. Sanitation Permit tl► ... base <br /> b Septic Tank (Specify Requirements) ......................................... .............................._...._......................................»............ <br /> ».... r I <br /> � y <br /> Disposal Field (Specify Requirements) ................................................... I <br /> ...................... ........................... .. . ... ............................................................................................................................................ <br /> ...................I........................ .-..-. _.. __..,.......................-...............................................................................1........................ <br /> ...... .4 <br /> (Draw existing and required addition on reverse tidal <br /> "! I hereby certify that t have prepared this application and that the work will be dont in accordance with fee dee4itlff <br /> County Ordinances, State Lawn, and Rules and Regulations of the Son Joaquin Leca1 Ha dA District.Menti was►al'or ll e� ; <br /> std ormfs sl«nature ceiifles the following: <br /> "1 certify that in the perfo^manor of the work for which this permit Is Issued, i shall not emptor Clay parson M suet,t+fwttfter i <br /> as fA btc t subject to Workman's Co p�snsa es laws of Califs!rnia." f <br /> Signed ... ..... 9ea..�,^. <br /> ..... .. .... .................. Owner <br /> By.... ..... .... .. ............................... ... Jltle . . ... <br /> (If other than ow�erl <br /> F 7ltDfPAffiMENTfiW0N1.V <br /> APPLICATION ACCEPTED BY . DATE <br /> 1lllbtNG PERMIT ISSUED ... . .r �' <br /> .�..,r .. ... .•......•.. <br /> 1..... . ........f ............. ...DATE .. <br /> ADDITIONAL COMMENTS ..................... .......... ...... ...... .... •- ....-. . .........................:.............. <br /> L.............. ....... .... . . . . ........ .. .... .... ...................... ...................... . <br /> ...-. . ... ..... ... ........ ...... ........... .• ., .. ...:... ................ <br /> Final Inspection by! -0 .......Dale <br /> EH 13 2t, 1-6ti Rev.�1 4-� N AQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />