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FOR OFFICE USE: APPLICATION FORT SANITATION PERMIT <br /> 6q �Yr.3 •_ <br /> ----- Permit No. . .. <br /> -"'--- --�-�����-��- (Complete in Triplicate) <br /> I Date Issued <br /> F + This Permit Expires i Year From Date Issued' <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the.work hereto <br /> described. This application iso�made t�,compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .Z ..- a- - --- ---- �I-- -.(T/./j•��/jn�y Jy ,._..CEFfSUS TRACT:--=._::-..-----------• <br /> Phone .._ -- <br /> Owner's Name ... -. s-r�?-..-. - . - -- . <br /> .. . <br /> Address 1 C i *- . <br /> Contractor's Name <br /> ...... -.-. <br /> hone <br /> .-. - I . ..----- -- License #✓63 - <br /> Installation will serve: Residence Apartment Ho`uteo Commercial railer Court <br /> it Motel ❑Other. <br /> Number of living units:..- Number of bedrooms .......... .Garbage Grinder ........ Lot Size .................. <br /> -..-. <br /> t /_KP, <br /> - - - Privqte <br /> Water Supply: Public System and name ------------------------- <br /> { at Sandy Loam] :. .Clay Loam Ll <br /> Character of!soil to a depth of 3 feet:' Sand Silt GlayM. <br /> is w• 1 <br /> Hardpan ❑ Adobe(] Fil#'hficYerial ..........:o If yes,type....�\..... ••--- <- <br /> „-(Plot plan, showing size of lot, location of system In relation to'wells, buildings, etc" must.be placedfion-reverse side.) <br /> u <br /> NEW INSTALLATION: INo septic tank or seep a pit permitted if u Ic sev=er is available within 200 feet` <br /> y <br /> -'P SEPTIC TANK Size ^J t :fly t,� - „.:•t. Liquid Depih :............. <br /> l?ACKAGE TREATMENT ( ] S ,� . �_ •� <br /> S+o a Material N._a."Compartments{} Capacity, . ---- - -- ype .. - -t :moi +P$�t <br /> i' stance to nearest Wefl .....••-- Prop. Line ................... <br /> L€ACHINGLINE [I , o. of Lines .-.-_. .---------------- Length of each' line:..._ -S 'f - Total Length ;-1-SO <br /> r <br /> V. Box- .i T e Filter Material .-.S..,R :.--..Depth FI ter Material .....1. ....-....• •-+'-----•----- <br /> _ r u --'�.a'I...-......_.. Property Line ._5;... • -_.:.--- <br /> r�.�.s.-........ Diem --.�-D.Q.--~--- Foundata n <br /> Distanc I' nearest: Well d�or�' <br /> De the j," bar ..__.....'a -----.----- Rock Filled Yes <br /> - SEEPAGE PIT. [ pFeterO <br /> Water Table Depth ........ - .� ................Rock Size ....... .... :... ..... Una ... <br /> Distance'to=rJearestg.<Well=• Fouhdation,.-.--.f Q- ---- Prop. Li St <br /> •. REPAIR%ADDITION'(PreV Sani#ation Permit# ------------ •-.--••--•-.---.-- <br /> Date - ..) <br /> Septic Tank (Specify Requirements) .... ...... � <br /> t irements) - ,-_.-_- --.-•---•-•-• r•-- <br /> ... - <br /> A' ................................ <br /> Disposal Field (SpIecify Regy.. ' <br /> ................. ...........t ..................... <br /> .-------- - .... ............... <br /> -� ' ....... .......'---------'----.........-...... ., - <br /> ::_...---..-_:.------- ---- --.--.------- - ------- <br /> r (Draw existing and required addition on reverse side) <br /> d <br /> i. 1 hereby certify that Ihave predyed this application and That the work will be done in accordance with San Joaquin <br /> County OrdiXances, SSW Laws, and Rules and Regulations of the San Joaquin Local, Health District.We a owner or licen- <br /> sed agents signature certifies the following: ersen in such manner <br /> "I certify that Fn.the performance of the work for which this permit is issued, 1'sholl net employ an p <br /> as to become subject to Workman's Com 'ensation'laws of California." <br /> Signed ------------- -----...... _ ..... .- . . ..-------.......-..... Owner <br /> By -..E ...- -' ____ _ __ <br /> Ix <br /> i (If other than owner) <br /> FOR'DEPARTMENT-USE ONLY <br /> APPLICATION'ACCEPTED BY - - - DATE --�. ............ ' <br /> BUILDING PERMIT'ISSUED .........--- -----.__.........................-------•--.._.._-..._ DAT <br /> ................. <br /> -.. <br /> ADDITIONAL COMMENTS'_,......A_................ ........................------------------------......-----------••-----------... <br /> !------ ------------------------ __..-...--- - --...----...I..--= - - .--...... ..._.......-- <br /> - ' - Dote <br /> --------------- - .... <br /> Final Inspection by: ----^. - �. : .-- -'................_... <br /> ..--'---'-------•••--.. <br /> i <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />