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FOR OFFICE USE: FOR SANITATION PERMIT <br /> _APPLICATION Permit No.. <br /> A (Complete in Triplicate) <br /> ---------- ---------------------------------------------- Date Issued <br /> This Permit Expires I Year From Date Issued <br /> --------- --------- ---------------------I---------------- <br /> an Joaquin Local Health_DISWd per�mll 10 romelcurl and . tall the work herein <br /> Application is hereby made to the S existing Rule' and Regulations:described. This application is made in compliance with Co�nty Ordina ce No. 549 and e <br /> JOB ADDRESS/LO I N ---- - ----- -- - --- --- ------- US T CT ----2-1----------- <br /> Owner's Name --- ------ --- -- - - --------- ---- ------ --­----------------- ----- <br /> ------------- cit� ------- <br /> Address <br /> Contractor's Name ------------- ------- -------------------------------------- -----------------------License #rilir Court------------ Pho e -------------------------- ---- <br /> > <br /> a' <br /> Installation will serve: sidence)?rApartment House-El Commerci�at -rc <br /> Motel El Other --------- ---------------------------------- <br /> Number of living units:-_-j--_---- Number of bedrooms qP L---_--_Garbage Grinder ------------ Lot Size - V.- ------__-_--__-- <br /> Water <br /> ---------- -❑ <br /> Water Supply: Public System and iame -------- ---------- --------------------------------------------------------------- ------ -------Private <br /> Character of soil to a depth of 3 feet: Sand.'El Silt El Cloy ja Peat Ej Sandy Loam J-] Cla- Loam 0 <br /> Hardpan E] Adobe-[] FiliMaterial ----------­ If yes, type ------------- -------------- <br /> (Plot plan, showing size of lot, location of systemr in relation to wells, buildings, etc, must be pla(ed on reverse side.) <br /> NEW INSTALLATION: JNo septic tank or seepage pit per nitted if public sewer is available within 20) feet,) <br /> PACKAGE TREATMENT SEPTIC TANKf I Size--------•-----------------------------.---------- Liquid Cepth -----------------•-------- <br /> Capacity ------------------ Type ---------- --------- Material--------- ------------ No. Compar ments ----------------- <br /> Distance to nearest, Well ------------ ------------------------Foundation ---------------------- Pri�p. Line ----------/--­...... <br /> - i 1 <br /> LEACHING LINE No, of Li6es -----I--_------------- Leng,h of each line------- ---- Total Lem th ----1-0-------------- <br /> - <br /> 'D' Box Type Filter Materi:Ae 4 MFilter Material ---------------------------------- <br /> p <br /> Distance.to nearest: Well <br /> --- — ---------- Foundation -­I-A-lf--------- Property Line. --IS----------- <br /> SEEPAGE PIT Depth --------------- Diame r,� ---------- Number .-----_--_---_--- <br /> _-.------ Rock Fill ad Yes ❑ N.o,C1 <br /> Water Tab <br /> le Depth ---- ------r------------ ----------- ------------Rock Size ------------------------------ --- <br /> Distance to nearest.. Well ----- ----- ------------------------Foundation -------------------- Pr Line ---•------------------ <br /> i <br /> REPAIR/ADDITION <br /> -------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ------------------- Date ------ 7/s�t------ <br /> .I ------------- <br /> Septic Tank (Specify Requirements) -------------------------------- ---- ---------------------------------------------.------------- ------ -----z._---- - -- <br /> -----5 <br /> Disposal Field {Specify RequAments) 7�. - -- - -------- --------------- <br /> -------------- <br /> ---------------------------------- <br /> ---------- ----------------------------------- <br /> ---- - - - ---- <br /> (Draw existing and req i <br /> iNre <br /> ----- <br /> % a reverse side) <br /> I hereby certify that I have prepared this application an j that the "r will be done(-" accorclan:e with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaq in L chi H e6nr-h Distriv. 11 ome owner or licen- <br /> sed agents signature certifies the following: <br /> I certify that in the performance.of the work for which this permit is is ued a y p Drson in such manner <br /> e P y <br /> California." <br /> as t su r m n' <br /> or <br /> u �Z <br /> Signe -- ------ 0 r <br /> Signed i. -- ­ -- -- -- <br /> S p �01-a of <br /> By ------------ ------- ---------- --- -- ------------------------- ------- -------11.5T� i t 11 ....V ---- ---- --------- ............ <br /> -------------------------------- <br /> (if other than owner) <br /> FOR DEk!tMET4T USE ON�tiL-, <br /> APPLICATION ACCEPTED BY -------- --- -- ------------------------ -------- DATE - ----- --------------------- ------- <br /> BUILDINGPERMIT iSSUED­----------'--1--------------------- ------------------------------------------------DA�E -------------- --------------- <br /> ADDITIONAL COMMENTS ----------- ---------------------------------- <br /> --------------------------------------------- ------- <br /> ------------ <br /> ------------ ------ <br /> --- .------ - ------- <br /> ------------------- ---------------------------------- <br /> e <br /> Dat <br /> ..... ------- ----- -------- \---------W <br /> final Inspection by; <br /> )A *- tbCAL <br /> SA JOA' U HEALTH 11ST' RICI <br /> E. H. 9 1-'68 Rev. 5M <br />