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FW OFIFICIE USE: <br /> 1APPLICATION FOR SANITATION PERMIT <br /> .................... ................... , <br /> T )Cenehte in Triplicate) Permit No. <br />.....................................v!............... <br /> " <br />.......................................... ... . ...... . Do <br /> . .... This Permit Expires I Year from Date Issued to lisued`.r.:: <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to .constr%ki,and I n6tall the work herein <br /> described. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulatlons, <br /> JOB ADDRESSAOCATION . .9.02(P <br /> .. . :....1/ . ...4...........CENSUS TRACT ........................... <br /> .......... .........Phone .................................... <br /> Owner's Name _4 ...... <br /> ?........ ..........*­*........ <br /> Address ......SA.....6........... ------ <br /> 451 <br /> Contractor's Name .... ------ License # <br /> kone <br /> ............................. <br /> Installation will serves It2ence O.Apartment House J:] Commercial OfIrlo' ller Court 0 <br /> I Motel E]Other..... <br /> 7............................ <br /> Number of living units_____________ Number of bedrooms ............Garbage Grinder .............Lot Size ....... ......... ........ ......... <br /> WaterSupply: Public System and name ....... I.................K.,.......................,._- .............................................Private <br /> E3 0. <br /> Character of soiltoadepth of 3 feet. Sand -".silt afj <br /> t Clay Peat 'SandyL*om❑ 'C <br /> :- ayLoomo <br /> Hardpan O�-Adobe 0 Fill If yes,type........................... . . <br /> Mot plan, showing size of lot, location of buildings, <br /> system In relation wells etc. must beSpl6ced on reverse side.) <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted..if public sewer is available w1kn 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK I Size__..._....--•:_--:: ._:... .................... 1.1cluld lbepth .... .................. <br /> Capacity ............. W'.' Compcirtments .'�L........ <br /> Distance to nearest:. Well. ................... .............4—Founclation .......... ............ Pr6p. Line�ft.................... <br /> I e,4�. . 4. <br /> LEACHING LINE No. of Lines ............. Length of each line.....................I...... Total -Len'g6 ............................ . <br /> V Box .._1_--•--- Type Filter..Material _Z-7*!k/ -7................... ................ <br /> e.- Depth Filter Material <br /> Distance to nearest: Welll ........ ......Kounclation ........................ Property ..... <br /> ............ rty Llni............... <br /> SEEPAGE-PIT Depth .................... Diameter ..........___ Number ............................. Rock Filled -Yes E3 NoO <br /> Water Table Depth <br /> ........:.....:.........••--- .....,......Rock Size .............I................... <br /> Distance to nearest: Well .............................__..._....Foundation ....................j pr6p. Line .................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................. Date ..................................I <br /> SepticTank (Specify Requirements) .................;................................... .... ... . .. . ..................................................... <br /> Disposal Field jSpedf;7—ReVU1-r-;;­krail. ..... ...... <br /> ................ ......... .................................... <br /> ........... ................................................... <br /> .......... ........... ................................................................... ....................................... <br /> ....................................... ......... ....................w...............................................a...................................................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I haveprepared thIs.applWallon and that the work will he done in,accardaitce "ll So" Joaquin <br /> I I <br /> County Ordinances, State Laws,`-and Rule's and Regulallins of the Son Joaquin Local Health Distdco.."Affl* owner or 111cerl• <br /> sod agents 09nature,ceirlifies the 411*wln'� <br /> "I certify that In the performan6`6fthe work for which this permit is Issued, I shall not aMploy any person In such manner <br /> as to becom ublect to Workman's CornIeusallon laws of California" <br /> . <br /> Signed - ...... ......................................... Owner <br /> By -.........................w.................... ..................*......*....... ......*---------- Title ................. .................. ............ ........... ........... <br /> (if other than owned <br /> gjFQ* D90ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..... ......................... .........DATE <br /> ... . . ..... <br /> ... ...... ..... <br /> BUILDING PERMIT ISSUED ........... ..... ......I................................. ...........................DATE ........ ......................... <br /> ADDITIONALCOMMENTS .................... ........ ............................................ ........................................................................... <br /> .................................. <br /> ...........I...... .......­-..:..........I...........................I.......... ......... .........*..."... .......................;........................ <br /> ..........................................................­.....'....­................... <br /> ... ....................................... <br /> ............................... . ......... . .... .. . ........ . ..................... <br /> Final Inspection by �. ...........LDat / 7................................. <br /> .. <br /> EH 13 24 1-61) Rev. SAN AQUIN LOCAL HEALTH DISTRICT 8/74 3M <br />