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FOR OFFICE USE: <br /> "'• APPLICATION t OR SANITATION PERMIT <br /> ------•------- ------ •--•--•••. -.-•--- n I . T 1;.. w. Permit No. <br /> ...._...�...��a.. _..._., <br /> . <br /> (Complete in Triplicate) <br /> _-_------ } ,This Permit Expires-1 Year From Date Issued Date Issued .�` (� <br /> Application is hereby made to the Sbn Joaquin Locoi Health District for a permit to construct and install the work herein <br /> described. This application ii made"'in compliance w•,it'h County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOC --------CENSUS TRACT .---------„-----• -- <br /> Owner's Name . .._. t' _ Q - <br /> ---===-------------------Phone -- <br /> Address ---•---•------- --------- t�•�.--��--•�----------------------. City ----------- •---_-------------I......... ------- -- - ----•----------- <br /> q <br /> Contractor's Name - -.- A.c�---. ti-c.. ----- ---.---.'`,.?.D/-�f_ .__I6 C _License gVio. 11.------- Phone ACk- �?a/--.--•-- <br /> Installation will serve Residence❑Apartment,Housef--i-C•-ommercialTraiher Court D <br /> �. <br /> Motel ❑Other ------------ ------- ------ ---------- f ' <br /> Number of living unit--Q-" Number of bedrooms`-t-------Garbage Grinder _jV....' Lot Size - •----•--- <br /> Water Supply:'Pub IicSystem and;name_.:--- ---------- ....... -------------- ... - ... -------------•----=- Private <br /> Character of soil to depth of.3(feet: W nd T Silt❑ Clay. , kPeat D', Sa#d Loam l]' Clay Loam g <br /> Hardpan 0 Ado be ❑ Fill Material -------- _- If yes,type,..... ..... ............. <br /> (Piot plan, showing size of lot location of s"lystern in. relation to wells, buildings, etc. must-be Iplald on' reverse side.) <br /> r n t.,..-..w-.._iQ 1 ! f "..tl ). —, <br /> ' NEW INSTALLATION: (No septi tank or seepage pif permitted if public sewer is avoidable 200 feet,} <br /> PACKAGE`TREATMENT [ ] SERI TANK Size___ _ __ . ._._.-.___.._ Liquid Depth ` .f____.......... <br /> CapactyQ ,�_ Materiat,� `. d c <br /> i .-- Type _-- _-__-� _--- No�ompartmenls�.�,�.............. <br /> Distance to nearest: Well -__�_._fl_----_____.X__ _.__Foundation , .._•__.___ Pro,P. Line-�r�•... ...___. <br /> ! ` ON f o l <br /> LEACHIMG LINE )( No. of L1 es ____ ____ _ ________ Length of each line_ _-..__. ---___ Total Length <br /> -_- Type PO._De th-Filter Material .`_ -_ ~ <br /> I � t r i � <br /> s D' •Box YP o P a <br /> Distance o nearest: Well _15 r ..~__-__ Foundation __ _f�__.�'._---- PropertyLLine <br /> 5 t <br /> SEEPAGE PIT t ] Depth -------------- ...... Diameter ---------------- Number --.---.--------.--!_.-.--_-- Rock Filled Yes ❑ No ❑ <br /> -11 <br /> k Water Table Depth .----- --------=-•-•-...........................Rock'Size _..A.... _--------- <br /> Distance <br /> -------- f <br /> Distance to nearest: Well _................__.._......_.._........Foundation --------- Prop. Line ..._._............... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..._..............................._........ Date ......•.•.... <br /> Septic;Tank (Specify Requirements} -------_--- --------------------- - -------- <br /> Disposal Field; {Specify Requirements) - ;......................._....... -- <br /> • 1 F <br /> _. <br /> ---------------- .___ -.._._____L.._............................. .-_..._......_._._ <br /> ' 1 S <br /> (Draw existing and required addition on reverse side) <br /> I hereby Itify that,�I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the.San Joaquin Local Health District.-44ome owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify thaP4in the performance of the work for which this permit is issued, I shall nol employ any person in such manner <br /> to becom s ject toi•l(Vork 's Compensation laws of California." <br /> Signed <br /> .. _ *`- -- ----- Owner 1 . <br /> Title <br /> Com. <br /> ( other.than owner} . `t <br /> FOR DEPART T O Y <br /> APPLICATION ACCEPTED BY _--------------- _____-_'_. DATE ..0fCV . _. <br /> BUILDING PERMIT ISSUED DATE'^. <br /> -• ----•-•---•---"-- <br /> - - -. <br /> ADDITIONAL COMMENTS ----............... . ......... -------------------- ................. <br /> .......................I--- --------------- ------••--•-•-------------...--_------ --------------------- ----- <br /> ------..........__•----'-•----'•--..._-- -....................._..........••...... --••-••.------••--- ca.•-•- ----- ----•------•------------­-- <br /> ---------- <br /> ---------•-• - <br /> -------------------- ----------- ------•---•--------------------•-----•-- --------- ------------ `]� <br /> Final Inspection b E-t - Date ----7 ..... ]- - ---------- <br /> --Y - - = - � . <br /> ' SAN JOAt�Ui LOCA SALT Dl RICT <br /> E. H. 9 1-'68 Rev. 5M <br />