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FOR OFFICE USK: <br /> t. I I P, APPLICATION FOR SANITATION PERMIT <br /> ...................... ....................... ----------- Permit,No. <br /> (Complete in Triplicate) <br /> .......... .............................................. — <br /> Date Issued --------ff- <br /> ------ <br /> This_krn�it Expires 1 Year From Date Issued <br /> .......... ......... <br /> Application is hereby made to the'Stin 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 existing Rules and Regulations: <br /> - <br /> JOB ADDRESS/LOCATION D--5-•••-- ----------- . .........CENSUS TRACT <br /> .....Phone ................................... <br /> Owners Nam .............°.W_E� F­L—------- <br /> P4 0, Boy M.I ....... ------ .................................. <br /> w _A�,/>/ <br /> ---------- <br /> Address ...... ---------? <br /> Contr ... ---License.0//------------------- Phone_. <br /> aaor's�,Name..........W. ............................................... <br /> Installation-w-illve <br /> ' J Residence E]Apartment House,E] CommerciaI;EjTraiIerXew* <br /> ,,se,r I . <br /> 1 ' Motel E]Other ----------------------------------- ------- <br /> -------N�.M"ber of bedrooms "7 ---------- <br /> .-2-_...Garbage Garbage Grinder Wo.... Lot Size <br /> Number of living Onit�,:� <br /> Private <br /> Water �u Supply: Public Systim. and name ----------------------------------­------- ------ <br /> pp , U <br /> Character of soil to a depth,of 3 feet: Sand F1 Silt El Clay 0 Peat❑ Sandy Loom Er Clay Loom C] <br /> Hardpan F� Adobe L] Fill Material <br /> If yes,type ..................... <br /> _ <br /> (Plot plan, showingsize of fatj location ;f"sysi-eim'in 'relation to wellS, buildings, etc. must"be e p16c6d ot?"re'yerse side.) <br /> ed if public sewer is available within 200 feet,) Ql� <br /> NEW INSTALLATION: (No septic tank or seeps pit permitted Liquid Depth ...... <br /> SEPTIC-iA Size.-Y <br /> PACKAGE TREATMENT j N K�7'[Pr <br /> Material_CONT nts <br /> Capacity ------- Type No. Compartme <br /> --------Foundation .140 !--t Prop. Line ........... <br /> Distance to nearest: Well ....... ... --------F6 <br /> No. of Lines ... 70-- ----- ...... Total Length <br /> LEACHING LINE Length of each line.... <br /> 'D' Box Type Filter Material R th C'-*.... <br /> a��jr-,___.Dep Filter. Material ....[7........... ..... <br /> -I/Q- ..........I e <br /> 1 FoundationProperty Lin <br /> Distance to nearest: Wel - ----- Ro k Filled Yes ❑ No <br /> Depth Diameter ................ Number ---------.................... c <br /> SEEPAGE'PIT [ ] I <br /> Water Table Depth <br /> :E�---KoCK-Zflze ............4. ................ <br /> ---- ------------------------- i <br /> .......... Prop. Line ---------------------- <br /> nearest: Well ........................................Foundation .......... <br /> ;-Distance to I <br /> ?. , ; ......... Date V----•-•-•...................... <br /> REPAIR/ADDITION(Pre�:`�anjtati ton Permit# _-------------------------------- --------------.......... ............................. <br /> Septic Tc�Ink (Specify Requirements) .................................................I---------------­ <br /> I .......................... . <br /> Disposal i'Field (Specify Requirements) --------------------------------------------------------------------------------------------------------- <br /> ............. ----------------------------------------------­­-­,-------- .................................................................. ................................................... <br /> ----- ---------------......... <br /> ........................ <br /> .................. ................................... ................................. ----------- <br /> -------- ................ . (Draw existing and required-addition.on reverse.side) <br /> I' 11 be done in accordance with Son Joaquin <br /> I hereby certify that I have prepared this application and that the work will <br /> County Ordinances, State Laws, and Rules and Regulations of the San Jocf4uin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: <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 /> I <br /> as to become'subilaws of California."Owner <br /> i W�r n, t* n i <br /> �k�n's <br /> ns <br /> ....................... <br /> Signed .......... ................ <br /> Title ... .... ... <br /> By ----- -----------------i------ ----------------------- <br /> pf other than owner) <br /> FOR DEPARTMENT USE ONLY ' <br /> C).F--4 DATE ._..3--.G>.-.7..0..' <br /> _Jol�t._A� ....................­ ---777=-:� <br /> LI CATION,ACCEPTED B ... -- ----1--S - ........... <br /> APP - -------- -_—DATE ----- <br /> .............. <br /> ........................ .0;...... ... <br /> BU I LD1NG-PERMIT-ISSUED----—----- _1 <br /> ............................ ........................... <br /> X X....... <br /> ADDITIONAL COMMENTS --------------------------------------\N ..... .. ----------- <br /> ..................................................................... <br /> .. -------------------------------------- ----- ........... <br /> - -------------------------------............................... ------------------- .................. ------------ <br /> --------------------------------------w---------------------------- <br /> ................. -------- ----------------------------- -----------------D--a--t-e-------7----:- <br /> .. <br /> V -- -- <br /> Final Inspection by: - ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F H q 1-'68 Rev. 5M <br />