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FOR OFFICE USE: Al <br /> APPLICATION FOR SANITATION PERMIT <br /> ............... ......... ------- ---------- Permit No;-7?.......� <br /> (Complete In Triplicate) <br /> . .......I------------ ................................. This Permit Expires 1 Year From Date Issued Date Issued <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 existing Rules and Regulations: <br /> I <br /> JOB ADDRESS/LOCATION _.--Z-Y(--V..i­---S-­,9­9 ------- -CENSLIS TRACT .......................... <br /> Owner's Name -----d..-C...... ....1,4,%v7..........................r----------- ----`•-------------------Phone --ji6jj.=.AVyY--------- <br /> Address ..............*V4-0...._,../- -------------------------------------- --------------- City ..../1 <br /> 0-194 ---- <br /> 45ck----- ----I .. .. <br /> ................. ..... ....... <br /> Contractor's Name ------_.L7 t./-A.... ------- ------...License --- Phone .......... .................. <br /> Installation will serve: Res'idence E]Apartment HouseO Commercial 9grZA&-6urt C] <br /> IMotel []Other------------------•....... ....... <br /> of living units:-____--- Number of bedrooms ..._...__...Garbage Grinder ............ Lot Size -------­--------- <br /> I <br /> Water Supply: Public System and name .------------ - --------------------------------------....... ------------------­­......................Private 10 <br /> r I <br /> Character of soil to a depth of 3 feet: SandO SiltO Clay 0 Peato Sandy Loam o Clay Loam.0 <br /> Hardpan Ej Adobe` ], Fill Material ....­----- If yes,type--- .......... --------- <br /> (Plot plan, showing size of lot, lc�ation 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 /> 1 .4 / lel <br /> 0 - <br /> PACKAGE j _)_SEPTIC TANK It+— §ize... -- <br /> jRk&jMENT­j -It- 0 -- -- --- <br /> - - ----- Liquid Depth ....40;.f....­-------- <br /> iridl...... — -- No. <br /> -CdMpartments <br /> .. .Capacity .... <br /> Distance to nearest: Well ......7jO.... ---Foundation .......... . Prop. Line <br /> LEACHING LINE No. of Lines --- - ------ -- Lo'nbth of each line .-Qkkf61­------- --- Total Length ...... ................... <br /> vp ...... <br /> D' Box ... ------ Type Filter Material ---!&Z2-�4 Depth Filter/Material ----- - - -------­--I­---------- <br /> 0.......... --,le---- .......... Property, Line ------- -------!........ <br /> Distance to nearest: Well ----7,o.... Foundation r <br /> SEEPAGE PIT I Depth ------------ ....... Diameter ..------- Number ----- ------------------- - Rock Filliscl . yes ❑ �100 <br /> L -==.Rock Size ........ .......Water -Table Depth ---- - ---- -- ..... . <br /> Distance tonearest: Well ........................................Foundation ---------------­--- Prop. Line ........ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..... ...................................... Dote ­......................... <br /> ti <br /> Septic Tank (Specify Requirements) ...... ------------ ....... .......... -------------­­­­............ ......................... ------- <br /> Disposal Field (Specify Requirements) .----------............................ .................­­.................................................... <br /> ;,I I.................... <br /> �­----a.................... ...... ... ...................................­.................................... <br /> -------------­--- I CY ." r <br /> it T-V ­.:-----------------------­- ............................ .... ... ...... <br /> ------------------- <br /> (Draw existing and required addition on reverse--------- ' <br /> side) <br /> I hereby certify that I have prepared this application and that the work will be done�Jo_dpEordjsrkce with San 43"quin <br /> 0 me owner licen- <br /> County ordinances, State Laws, and Rules and'iRebulcrtions of the San Joaquin Local Health District. No 6r <br /> sod agents signalurkiertifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any jerson In such manner <br /> as to'became <br /> suble t jo "rkma!� <br /> sCo m a son <br /> laws of California." <br /> - <br /> _' . ..Signet�7 _ <br /> By ---'----------------------------- ----- .. . ... ------------­----- <br /> .............. Title ........... --- ---- ----- -- ---- ----- -------- ....... <br /> (if other.than owperEl- <br /> D ARTMENT ONLY <br /> ---- DATE ...... ...... <br /> - --- -------- - -- --- ------- <br /> • <br /> APPLICATION ACCEPTED BY .4 DATE----------------"-------------- ------- <br /> BUILDING-PERMIT-1SSUED-7---- -- !n--------- ........... . ...... . . <br /> --- - I-.,- - �..................... ........ ----------*--------------- <br /> ADDITIONAL COMMENTS -------- ............................... .......... ------ i� . - ;�V...... <br /> ............ ----------- ----­...................... -----­----------------C�------------V........r�.............................. ---------- ---- <br /> %� � \ � - ,- _..... ...1--�k....:tN�--------------------------------- .. ...... ........................ <br /> ...................... ......................... --­--------­-------- - <br /> ---------------- - ------ <br /> P. .....;�------------------------------------------*........... --------I....Do,,- 1-7 <br /> ---b-,y-,:...................V'- <br /> Final Inspection <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />