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FOR OFFICE USE: <br /> A PLICATION FOR SANITATION PERMIT i <br /> Permit No 7 3'�Dy I <br /> fiC Q a;y (Complete in Triplicate) , <br /> �rF� ......................................................... <br /> + „ Date Issued ... <br /> ,••-,•„,„ ,,,,,,„;,,,,,,,• This PermitEzailth Distres I rict form Date <br /> permit to construct and install the work hereinr�t"�"� t <br /> Application is hereby made to the San Joaquin Local He <br /> described. This application is made in compliance with County <br /> Ordinance No. 549 and existing Rules and Regulations: ata R°tl' <br /> JOB ALDRE55/LOCATION o? / —......... .........................CENSUS TRA �4a 6�r7 <br /> n v <br /> 4 <br /> } _ <br /> Owner's Name ......._ . .. r Phone' <br /> -p <br /> ....... . .. 4 <br /> y C! <br /> Addre:rc,o./�..../!" .!!G¢f,/.. .. ... ........ ..................... ..... city� . ................. ... �r�� <br /> r <br /> Contractor's Name .... . .. rR. <br /> PhoneInstallation will serve: denc partment House❑ Commercial ❑Trailer Court 0 <br /> � a <br /> s Motel ❑Other_... ............................ ........ <br /> r <br /> Number of living units:...... Number of bedrooms .......Garbage Grinder ....0... Lot Size ... ... . <br /> ` Water Supply: Public System and name ........... Private�l <br /> _.. <br /> r Peat Sand Loam (� Clay Loam ❑ <br /> Character of soil to rs depth of 3 feet: Sand•❑ Silt U Clay ❑ ❑ Y ,\ <br /> k y Hardpan E) Adobe ❑ Fill Material ............ if yes,type ................. <br /> v (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) , <br /> h t <br /> a. NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet;) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK t J Size................................................ Liquid Depth . .... - <br /> .. rr1 K'i .C. �J14erial... ........... ..... No. Compartments <br /> Capacity J. Type <br /> ...�.�.0...`.. <br /> i <br /> Distance to nearest: Well ...... � Foundation :`..�...:............ Prop. Line <br /> f ... ......... ......... `C <br /> ! LF.ACHING LINE ( ] No. of Lines ...�.... ..: .. ...... Length of each !ire ..L d-.P. Total Length '1 / - <br /> G <br /> D' Box --/. Type Filter Material .3.Al depth Fitter Material ...L.�.... .•. <br /> ... . <br /> 1 . Foundation Property Line No C <br /> Distance to nearest: Well ....... . .. .. ...... <br /> SEEPAGE PIT [ ] Depth Diameter .. Number .... .. .. . Rock Filled` Yes <br /> ....Rock Size ... .Water Table Depth <br /> N eR I' Foundation Prop. Line ...... <br /> Distance to nearest: Well .... ................................. <br /> '4p✓rV. J YDate ......................) <br /> VN REPAIR/ADDITION(Prev. Sanitation Permit# ........ .. <br /> (7 v <br /> Rn ts) ...... /.!i. ........... ........................................................................ <br /> Septic Tank (Specify Requiremen <br /> 5 <br /> .Disposal Field (Specify Requirements) ..r!.b..�- ••t� 1 L ✓ I'LU....F�..-• •- - <br /> r a ............................... <br /> ....... <br /> ....................................................................... <br /> .......................... .. <br /> .......... <br /> -� � �� (Draw existing and required addition on reverse side) <br /> i <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> lations of the San Joaquin Local Health District. Homo owner or Ilton <br /> County Ordinances, State Laws, and Rules and Regu - <br /> 'y sed agents signature certifies the following: <br /> F "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 Owner <br /> .. . <br /> 1rot <br /> .. Title yr tha caner) <br /> FOR DEPARTMENT USE ONLY <br /> r �— — <br /> ' DATE ..lb..'..Z... <br /> APPLICATION ACCEPTED BY �. .......... DATE ................................. <br /> BUILDING PERMIT ISSUED .... ................. ..........................................o........................... <br /> ........... <br /> ADDITIONAL CGMN.ENTS . . .. .................................:........................_...:,.,......................-..................................... <br /> v ................................................- <br /> .................................................. <br /> Tti: a - .., ..... ....... <br /> 1Q.... s <br /> 4 <br /> .... .. ..........Date ... <br /> ............................... <br /> •- '� <br /> Final Inspection by: .. .. :. .. ��•--•-•• � � • <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT j <br /> ' <br /> 1• 68 Rev. 5M <br /> ,. E. H. 9 -•-- <br /> A,' <br />