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i <br /> .r <br /> FILE COPY <br /> x. <br /> FOR OFTICE USE: APPLICATION FOR SANITATION PERMIT b <br /> Permit <br /> (Complete In Triplicate) <br /> ........... This Permit Expires t Year From Qate issued Date <br /> c......... ................. ..... ... <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application Is made In compliance with County Ordinances No. 549 and existing Rules and Regulatlatter <br /> } .a ?JOB ADDRESS/LOCAT .. Z �e <br /> :!.."�`.-`...�..��✓ ..f .....•. ......CENSUTRACT ..... <br /> Ower's Name . ... Mane.....I.............n »•....................«........ <br /> Aadss ................... .. .. .... � City,.... . ...............................•..... <br /> �] +•-�4. �� j' Phone <br /> Contractor's Name ....... 1 5�. ......d - .. ..... . . ...•.............11eer►te tP� ...............»»».....�. <br /> rl, , <br /> installation will serve, <br /> Residence Apartment Housefl Commercial pTrailer Cour! ❑ <br /> Motel Q Other. <br /> .N ... ..«.....«......r.•».•• <br /> .L. . Number of bedrooms ...Garbage Grinder ............ Lot Sine r, <br /> .Number of living un1t:,.. . ••• •••••• ••••••••••• »••�•• W ' <br /> r <br /> "Water Supply, Pubiic System and name ..................................._............,.. .;..,...»....:.,.....».,.:....,..:.....................Privoh <br /> Character of soil to a depth of 3 feet, Sand U] 1!Q Clay ❑, Pea! Sandy Loom(3 Clay Loarn❑ <br /> " Hord n Adobe FIII Matwlal . if <br /> � Cl ..,.,. yen,type.....,..................... <br /> {plot plan, showing size of lot. location of system In relation to Wells,:buildings, eft. muo be placed an rwMM <br /> Nt11N INSTALLATION INo septic tank or seepage pit permitted If piddle sewer Is available within 200 festa <br /> PACKAGE TREATMENT O SEPTIC TANK( Sixe..........». ..» ...................liquid Depth ... <br /> . P <br /> . : Capacity .................... Type ........... ...... Materkll•:.,.«.............. <br /> ... N0. Cont ................»... . <br /> f Distance to nearest, Well .......................... Foundation }� <br /> NN•»i Y .•.N....«.»•,.i.,Y.Prop.Lina w..,,w..•.Fw.�.•-•• <br /> B LEACHING IINE ( ' No. of lines ...... ................. Length of each line..:................,........ Total lattgth ........... <br /> •D' Box ............ Type Filler Malarial '' 4111w Malw%l ".......»...... <br /> Distance to nearest, W111 ....»... fettetdatlon ....................... Prepasly Line .:.:.....»...»....... <br /> l:PAGE PIT O Depth ..... .............. DlamoW .. »..... Mtmbar ,..........«:...:.Y...:..:. Rods Hued Yat © No C7 • <br /> Y Water Table Depth ...........:............»»...........:........Rock Sl:;o...»...«.........»......»... <br /> Distance to nearest,Well Fouttdafion Prop. <br /> .� ........................................ ........:..»..».» Line:»........,.._..._. . <br /> REPAIR/ADDITION Prev. Sanitation Permit tP <br /> a` ( ............... .••••»....r...r...... Dasa .•r..........».....:...........1 . <br /> 1 •. <br /> R i Septic Tank {Specify Requirements) ........................ ....»....«..............».. .,........_.......».» �......_....._..........».... <br /> Disposal Field (Specify Requiremenhl .. .... ... ..... .....»»...».»...... <br /> .-. . <br /> c?� •.l...R»'.-�.t* ...�t..........� .:r. »..........................._� ,: <br /> ;.: .�. <br /> . ..................................................: ..... ...... � ..r....»«......... ....... <br /> ......................:..:.� .».....:.. <br /> . "'(Drow existing and•required addition on reverse*kiel•`r <br /> t 1 Lby certify that I have prepared rhls application and chat the work wig be dette M exttatdarroe wlltt4on Joaquin- <br /> County Ordinances, Stat• Laws, and Rules and Rogvialisna of the fan Jo"Wa Loeol Nsolf! DkVkC Nonce owner M peers• <br /> sid agent*slgnature certifies the followingi <br /> "1 comity that in the performance of the work for which this perrnll H issoW,1 shod uet employ city porsew M sada 00"Wes <br /> es to betome subject to Workman's Compensation taws of Califerwoa" <br /> Breed.......... .......... ...._ rX ............... <br /> o -'y .. ............ - �.J,� . .rt.... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED I3Y . :'•'.'s'�'{:�rs..Gs r ..............»..................................... DATE.lL.��:.Z.3.... .....:....�. <br /> BUILDING PERMOIT ISSUED ....................................................................................................DATE........... ... ...._.......«._.... <br /> ADDITIONAL CMM[NTS <br /> .......'......................................... ................... ... <br /> ......................................• .................................................«..«.-«-...............«......... j <br /> Final Inspection byt .:�.traces.: .........................................................«....Qat, 1 ..•. .. iz.»..........»....... <br /> r_ <br /> l SAN JOAQUIN LOCAL HEALTH DISTRICT <br />