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FOR OFFICE USI±: ppLiCATION FOR SANITAION j?+ERMiT <br /> Permit No. _�7 lk S-V <br /> �-- ---------- ---- --------------- 'Complete in Triplicate}` <br /> }� y Date Issued -. �----- -��. <br /> _ _________,______ p <br /> This Permit Expires 1 Year From Date Issued <br /> l the work herein <br /> Application is hereby made to the.San Joaquinnin ec wHealth <br /> +l?CounDty District <br /> a for a No. 549 and existing Rules rmit to construct and tand Regulations: <br /> described. This application is made in co p <br /> _ -------------------•---_ <br /> .._ ..w- _--CENSUS TRACT -- <br /> JOB ,ADDRESS/LOCATION <br /> one---- ------------- ------ ------- <br /> Owner's Name -- --- ----- - ------•-- <br /> - -- -- ---------- <br /> } - ----- -------------- City <br /> ---- - ----------- ,. ,. <br /> Address --------------------=---- - - - -- -- ------ ---- - •-- <br /> G ` Lice # t 7 Phone - <br /> Cont�actor's Name i <br /> Installation will serve: e'sidenceXApartment House Commercial:❑Trailer Court !,❑ } <br /> Motel ❑ Other ----------------------------- <br /> Number of living unfits:-p"-�--Y_N Number of bedrooms -- ------Garbage Grinder ----------"i Lot Size - Private <br /> Water Supply. Public System an name ---------------------------------------------------------- <br /> Silt <br /> --------------- ------- - <br /> ----•--- ----- - <br /> ------------- ----------------- <br /> P p Y- �----, <br /> I Peat❑ Sandy Loom �] Clay LoamF] <br /> Character of soil to b depth of 3 feet: Sand❑ Silt❑ Clay ❑ + <br /> Fill Material ------------ If yes, type ------- - --- --- <br /> Hardpan ❑ Adobe'❑ <br /> (Phot plan showing size f-lot , location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: �(Nd.septic tank or seepage pit permitted if public sewer is available within f ht,l 'V <br /> �L <br /> i --•--- <br /> I PACKAGE TREATMENT [ ] SEPTIC TANK'{ ] Size----5'Y_--t.�� lz q p <br /> / <br /> MaterialC> tNo. Compartments -- <br /> Capacity P <br /> ' 1 ______ ... 7-0-------------------Foundation - Prop. Line . <br /> Distance "to nearest: `Weil_'-- _-_ <br /> i t '_4-------------- Total Length �b <br /> No. of Lines ------------------------` Length of each line__- <br /> LEACHING LINE C ] { ,,, i l�- <br /> 1 Depth Filter Material --------�-�1-------- Vs <br /> i D' Box . jo�a--- TYPe�Filter Material --------------- - P <br /> i "'% s O-- ------- Foundation ---f.-�------ ------- Property Line ----�'�-----•------=---- <br /> Distance:to nearest: Well g----- <br /> ..� �- ----_-----_- Rock Filled YesX No !❑ <br /> I SEEPAGE PIT �}-�� Depth ��-7- ----------- Diameter $_Y_f0---- Number ------------ - - <br /> �— ' ' ---•Rock Size -------------------------------- <br /> Water Table Depth -------------------------------------------- <br /> i <br /> ------------------------------------ <br /> Distance to nearest: Well - -`----------- ----------Foundation -------------------- Prop. Line -------------}--•: <br /> I REPAIR./ADDITION(Prev. Sanitation Permit# --------- - Date ---------------------------------- 6 <br /> i 4 <br /> ------------------------- <br /> ---------------------------------------- g <br /> Septic Tank (Specify Requirements) ---------------------------------------------- <br /> Disposal Field (Specify Requi�emerats}�1'= <br /> --------------------------------- <br /> ---------"-------------------------------"-------------------------•--------------- <br /> ---------------------------I-------- ----------------------------------------------- <br /> '-------- - ---- -- --------------•--------------------------------------------------------•---------- <br /> ----------- "--"" --------------- , - (Drams ex.sting,and required addition on reverse side} <br /> ne in <br /> ce <br /> h Son Joaquin <br /> . I hereby certify that I have prepared this•.applicaei°t^la�i d that <br /> the San Joaquin LocalHealth District.nlfometowner or ltcen- <br /> f <br /> County ordinances, State Laws, and Rules and � g. , <br /> sed agents signature certifies the following: T <br /> "I certify that in the performance of the work for•Which this permit is issued, 1 shall not employ any person in such manner <br /> as to become subject.to W, C <br /> _orkman's ompensatsony laws of California." <br /> � ____. Owner. <br /> Signed ----------- ----- --------------------------------------------------------------------- ---- <br /> t ---- --------- <br /> BY -- -- <br /> --------------- title <br /> {If other than owne <br /> t FOR DEPARTMENT USE ONLY <br /> - �-� - _ <br /> DATE ---- . <br /> APPLICATION ACCEPTED BY DATE - -- <br /> BUILDING PERMIT ISSUED ----------------------------------------- <br /> -------------- -- ------------ <br /> ADDITIONAL COMMENTS ----------------------- -------------------------------------- <br /> ------------------ <br /> --------------------- -------------------------------------------------------------------------------------------------------- <br /> ----- ------ --------------- -------------- -------------Date --- --- ---�--�` ------ ------ <br /> ------- ---- --- ------- --- fir' <br /> --------------- <br /> ------------------ <br /> � Final Inspection by: _"--------------- - -- - - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />