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FOR OFFICE us APPLICATION FOR SANITA TION PERMIT <br /> .............I......... ----------- {Complete In Triplicate) Permit No. ............... <br /> Date Issued ....IL n4p� <br /> ..... . This Permit Expires 1 Year Frown Date issued <br /> .....1.11............I............ <br /> Application is,hereby made to the S6n Joaquin Local Health District for a permit to construct and Install the work herein <br /> ein <br /> described. This application is made in compliance with County Ordinance No- 549 and existing Rules dind Regulations- <br /> TRACT .................... <br /> JOB ADDRESS/LOCATION Wl_�_CENSUS`l <br /> -------­------­--Phone <br /> Owner's Name ---------/11,z-------4 <br /> . . ......... . -------­­.............­­.......... <br /> 'Address ..... IL-7A,,�'Ze44W — ---------------------city <br /> ----------------- <br /> -IN - <br /> Contractor's Name <br /> ....License# ..........------------- Phone ....... -----------------_--- <br /> C--------- !6.....I................. ...... <br /> Installation will serve; Residence Apartment House 0 Commercial oTraller Court 0 <br /> Motel E)Other................... ........................ <br /> Number of living units:------•----- Number of bedrooms ....Garbage Grinder ---------­ Lot Size- ..................................... <br /> ........:.:-.Private <br /> Water Su ❑ <br /> pply.• Public System and name .........f-----------......____............. ............................... <br /> Character of soil to adepth of 3 feet; ScirrdEj SiltO CIOYCI Peat[] Sandy Loam o Cloy-Loam 17' <br /> Hardpan E] �dobe 0 Fill Material ............if yes,type.......... <br /> - <br /> jPIot pian, showing size of lot, location Of iteVin relation to wells, buildings, etc.' must be placed an reverseside. <br /> f <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,l <br /> PACKAGE TREATMENT I I SEPTIGTANKt Size----------------------------------•--- ------- Liquid Depth _............. <br /> Type ------ <br /> _4rVH-Nb. Compaiprients <br /> Capacity <br /> Well A <br /> I <br /> 4­i' _rop. line <br /> Distance to nearest _4.......... .......& <br /> �0, 'Length LEACHING LINE No. of Linis ....------ ------ Length of each line--- -7 . Total i <br /> I D' 6 '1____' Ty;ie Miter Materyll ....................Depth Filter Material ...........----_--­-_-.7----------- Nj <br /> Box <br /> Di nearest: Well ......... Foundation 4F----------- <br /> stance to neare .V ­ <br /> kEPAGE' PIT Depth ---------------------- Diameter ---------- Number --•-------•-•----------._..-,.Property <br /> Filled Yes El Na 10 <br /> Water Table Depth -------­­1---------------------- •-----._-Rock Size ----__-_---------------- <br /> Distance to nearest. Well --•------_-••--•-•........................Yqunclation ....................• <br /> Prop. Line ------ ----------- <br /> I I Permit# ------- ---------------------............. Date ------.-_-._...----.__.___----_-.1 <br /> REPAIRADDIVON(Prev. Sanitation <br /> Septi.6- -------- ..........__--------------•- -_ ............. <br /> )T,,k (Specify Requirements) ---------........... f <br /> '1111,11i � �� ll,���I����,,I I ir ig <br /> ji! 1 !, 11 � ....I.......... ..................... <br /> --------------- --- <br /> 01spbira Fiald-fSpecify Requiremenftl --_,_4R inn 1_1'':1!! !71. <br /> - ------ ---------- ........... <br /> ..... .............. ...... <br /> -----------...................................... <br /> a V a i1a kg� --------- <br /> ri6 - ------------------------------------ <br /> - - .... ..... .... <br /> ------ ----------------------------- (Dra existing 6n requinid addition on reverse si�r <br /> I hereby certify that I have prepared this application and that the work will " done In "CcOrdancerLwith So" Joaquin <br /> County Ordinances, State Laws, and Rules and .Lie'UMflons of,the Son Joaquin WWI Health District. Hi'me owner or Hcon-I:, <br /> sect agents signatvire certifies the following- a <br /> I;i codify "t in tho porfenwtance of the work for which 4hk permit is issued, I 9h`Wl linct"emPtsy any person In such fflamw <br /> as to b"M bleat to Warkm M lion ftwe of CG'IKom' <br /> A <br /> .......... ner <br /> I'i <br /> By ------_-----_--- ------ -------------- Title j-----------1 ................. ......................... ...... <br /> --------------------- ----­----------------- <br /> I (if other than owner) <br /> Folt varAwrWiNT qSE ONLY <br /> ............................ DATE - -- -- ---- ........ ......... <br /> APPLICATION ACCEPTED BY <br /> QATE-----------------­-----------­-­-- <br /> &RDING PERMIT- ISSUED -------- ...................... <br /> ADDITIONALCOMMENTS---------------- .................................................................................. .......................................................... <br /> -A .........................••--_.I..,__......._•-------_-- <br /> - - .. . .. ............. <br /> ------------------------------- ......................................... . <br /> ------------- ......... ............. <br /> I.- V�j <br /> ....... ------------------- ---------­...................... ...... ate tx- <br /> -------- <br /> FinalInspection by: ... --------- ...... <br /> ---------------------------------­­­..------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT. <br /> E_H. 9 1-'68 Rev. 5M <br />