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' t <br /> k <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ��// <br /> ... <br /> Permit No. .%Y.'-�� <br /> IComplote in Triplicate) <br /> ... Dote Issued .7.:j <br /> .. .,..._ ._.,•-..-,.•-• This Permit Expires I Year From Date Issued - <br /> Application Is hereby made to the San Joaquin Local Health District for a p,rmit to construct and install the work hoc <br /> desoibed. This application is made In compliance <br /> 't..with County Ordinance No. $49 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIO <br /> nnN -.......II� . I. _......VV...-.._L/ARCH.... � ..__ .....CENSUS TRACT ,�>-. -_... <br /> Owner's Name .. - .Nw.1.�..........1:f.. N.s..t�^(..........................................................Phone ................»...»»� <br /> Address / a o.�.-E'..........LV........i�!q.Bc.H:...... .....city ....••-f••I.3/"+C/ <br /> .. .- . . .... <br /> ..................... <br /> Contractor's Name .. ....Q.LV/.O.-�...................................................License# ........................ Phone ...........___ <br /> Installation will server Residence�rlment House C) Commercial❑TrolierCourt Q <br /> Matel❑Other....... ............. ..................... /MyQC� <br /> Number of livingunitst.. -f Number of bedrooms S...Garbage Grinde►A(a... Lot Size .....(Tri. E.M-4'.-PF—_— <br /> Water Supply, Public System and name ............................�Z.�{...!9�j.Y...... ......».............................private,❑ <br /> Character of soil to a depth of 3 feet, Sand❑ Slit❑ Clay ❑ Peat❑,�/ m C) d <br /> Sandy Loom loam�— <br /> Hardpan❑ Adobe ❑ Fill Material..i'!fl2...If yes type............................ <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, ate. must be placed on reverse side.) <br /> NEW INSTALLATIONt (No septic tank or sea pit permitted If public sewer is available within 200 feet,) <br /> le <br /> PACKAGE TREATMENT ( ] SEPTIC/TANK( Size.....-. `1 I1...X ............ Liquid Depth ..../4.1 .. ......_- <br /> Copodty . ($?�o... Type Pl........� � T Mtshrial TNS.KT-fro-.Compartments ..---� ....._ <br /> / istance to nearesh Well ........ ... ......._.......Fou otion.....f............ Prop. Line..:�»»_..»sr..- <br /> 41 <br /> 2yo <br /> LEACHING LINE (1 Nct of L�irys ............. length o each line ---5 ... ........._ Total Length ........ _._. i <br /> }y� .i i <br /> D' 80 TEG .. Type Filter Material ..Q»C�Dapth Filter Material --_,i.7--------------_--I...1.... O <br /> Distance to nearest, Well .....�..�.... Foundation .....IL'... .. Property line .... ......--- 6 <br /> SEEPAGE PIT (A, Depth -.... . - Diameter ................ Number ......... _. ... Rock Filled Yes ❑ No Q <br /> Water Table Depth ..............................................Rock Size ...........».................. <br /> Distance to nearest:Well ........................................Foundation .................... Prop. Line ....... »_ <br /> REPAIR/ADDITION(Prev.Sanitation Permit# ................. ... Date ...............................) <br /> Septic Tank (Spedfy Requirements) ........................ ................................................................................_..._... <br /> ...r..»»»......_ <br /> ................................ <br /> Disposal Field (Specify Requirements) ......................................................._. <br /> .........-............................................................................................................................................................................ <br /> ................................. ...P..._.....-.......PP-...-............._........-.._....-.-.......-..-......................-.............-..............................-..-._ 9� <br /> (Draw existing and required addition e-n,averse side) <br /> I hereby <br /> ve <br /> cation and <br /> hat the work will be <br /> ne in <br /> ance with Son <br /> ccluls <br /> County Ord nances,rStal a laws, and Rutles and l Regulations tof the San Joaquin Local oHealth Distrrict.Home owner err licen• <br /> sod agents signature certifies the following, <br /> "I certify in the perform n of the work for which this permit is Issued, 1 shall not employ any Person in such manner <br /> as to b ePe}ubletl W en's Compensation laws of Celifemia.'• <br /> SignedNQt ZP . f7 'Y.l....'......... ........... Owner <br /> By ._._................... <br /> . . .............................. <br /> pf other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY..... -:U'.... ..-LJE ...�>.`-• kJC-.............4 ................. OATE....../,r.'rC'`.... 0---jr........... <br /> BUILDING PERMIT ISSUED...................... •• .• ...... ' "" "" <br /> DATE ....... <br /> ADDITIONAL COMMENTS... r r- D.�r....-. ....70PVr;r;" ......L�X.�I.. A.:-�.•�•••+......._._....................... <br /> ............. ..._. ............................................................. <br /> ..................................... <br /> ................... .............-... ... .................... .......... ............. _�2_ ............... <br /> . .. . .... ........ <br /> ... . ....._...... ........... ... . ............Oeste ... ........�... <br /> Final Inspection •fY`",... ...... ..... ..... .................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 7/7239 <br /> E. H.13 24 1-'68 Rev. SM <br />