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FOR J OFFICE USE: , ,_] APPLICATION FOR SANITATION PERMIT <br /> ........ Permit No. ... . <br /> (Complete In Triplicate) ...... ... <br /> This Permit Expires I Your From Date Issued Date Issued 7- 2L4 <br /> . .......... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in compliance with County Ordinance NO. 549 and_,,9 'sting Rules and Regulations: <br /> ,6,4- 1 <br /> JOB ADDRESS/LOCATIaN 3 a, -Al---- OWCENSUS TRACT -------------------------- <br /> e..... ..... ....-Phone - ----- --------. . ............... <br /> Owner's Name ...15re f; � x ----- - ------------------------- ----------- - <br /> --- --- ------ <br /> 4?P . . .... . __/......A01 ------- <br /> Address ----- -------- ---/ AIV .....City ............................. <br /> Contractor's Name r4e 44"_---------------....:........License Phone 0go—�:24.1C/'o; <br /> Installation will serve: Residence;N Apartment HouseC] Commercial OTrailer Court C] <br /> Motel EI Other ................... .................. <br /> Number of living units:.-.- ---- Number of bedrooms _411'----Garbage Grinder lVd!-'V Lot Size --------------- <br /> Water Supply: Public System and name .......................................................__---------------------------------------....--Private <br /> Character of soil to a depth of 3 feet.. Sand r] Silto Clay E] Peat E] Sandy Loamx Clay Loom <br /> Hardpan C] Adobe E] Fill M6terlal ............If yes,type----------_........ <br /> (Plot plan, showing size of lot, location 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 0 .1. <br /> Depth . --------------- <br /> �`fC�l Liquid <br /> Capoci44V---1210VrYPeA1A Material No. Compartments �d <br /> -e <br /> Distance to nearest: Well --Foundation Prop. Llne .jk..�.......... <br /> LEACHING LINE 94 No. of Lines, ? _ Length of parh line/"- Total Length gjA�?............. <br /> 'D' Box Type Filter Material/114WA6e, F'# <br /> --Depth Filter Material ,-/�O....__............ ......... <br /> /29--- ---- -- Property Line ­5teel- <br /> Distance to nearest, Well __940------------ Foundation --- ...A.............. <br /> 0) A�/ V 2-V <br /> SEEPAGE PIT Depth ---of.w---------- Diameter le Up ...... Number --- --- Rock Filled Yes)X No C] <br /> Water Table Depth -----�A��..............................Rock Size ------ <br /> Distance to nearest: Well .. .3.Q-.-_-.--."--..--.__...Foundation .45io---------- Prop. Line __l;147.......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- - - ---- --- --- -------- Date ----------------_-----.--_---__I <br /> Septic Tank (Specify Requirement;) ------- ------------­---------------- ----------------------------------------- --------­....... <br /> Disposal Field (Specify Recivicements). .......... ---------------•------------- ----------- - ----- ----------------------- <br /> ...........................---------------------- ......I................................................ ............. .. ---- ----­........................ <br /> ........................................ ---------------- ------- <br /> ---- ------- ....r;--------------- --------and required addition on reverse side) <br /> ................ <br /> I hereby certify that I have propo t4is appilicition and that the work will be done In accordance with Son Joaquin <br /> County Ordinances, State Laws, am iltules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifi@s theoJ p wing: T <br /> "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed --------------- ---- --- -------- ------------------------------I— Owner <br /> By ..-..... <br /> ..... .. .. ...... ---------------- Title <br /> ?(11'o6th,r than owner) C',..-.-...;\---------._-...... <br /> FOR DEPARTMENT USE ONLY <br /> APPLI(IkTION ACCEPTED BY oFkz me <br /> ------------ -- ----- --- ------ �D�TE ------ <br /> BUILDING PERMIT ISSUED------------------------ ---------- ------------------------------------------ ___----------------DATE ....-------------------------------------- <br /> ADDITIONAL COMMENTS .... . ........-------------------------- f <br /> -------------- --------- <br /> ----------------------- --------------------- ............ ----------------------- - ------ -- ------- --- -- ---- <br /> -----------------------­--------------- -------------- ---------------------- ------------------­-- 8 <br /> .. ............ ---------------------------------- <br /> -------------- -- - ----- ------- ----- -- -- ----------- --- -- - -- - ----- ----- -----I------------------------------ <br /> inal Inspection by: -------------- -------------........ U_?!�JA ._-----------.......................-----Date <br /> )ku <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H. 9 1=68 Rev. 5M <br />