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' FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> J <br /> ­_-11./ <br /> i � IComplete in Triplicate) - No. . <br /> �._ . . Permit <br /> Date Issued ZZ. _.�.....76 <br /> .................�`.... This Permit Expires 1 Year from Date Issued <br /> Application'is hereby made to-the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application is made in compliance ith County Ordinance No. 549 and existing Rules and Regulationsr <br /> 108 ADDR1r5S/LOCAT ON.._. a ... ,ct.� .....- -- •- ... --••---"-. .. ..... CENSUS TRACT ..... <br /> Owner's Name,-,%—,.,: ... .. ............ ............... ........... on _...-:®7. . ,- <br /> Ph � � '� / <br /> Address ........ 2_4L ....,.City /.. . ....--- ... .._...... <br /> Contractor's Name ---...i . . -.;. .: .- _ ..License c'r,% f . .' Phane-�t�6.�.-�6.� .. <br /> Installation will serve: Residence[(Ap!artment House t3 Commercial[Trailer Court fl <br /> Motel❑Other --------•-•. ............. . . ` ...:.. <br /> G Number.of living units:-- _ ...... Number of bedrooms ....Garbage Grinder ............. Lot Size ... ............��L`..`.. <br /> 1 Water Supply: Public Syste n and name ...----•- ........................ ..a. .............................................Privote <br /> Character of soil to a depth of 3 feet: Sand E] Silt❑ aay ❑ Peat❑ Sandi► LootrAg:_Clay Loam❑ <br /> Hardpan Q Adolfo❑ 'Fill Material'...........If yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system=in relation -to wells, buildings, etc, must be placed on' reverse side.) <br /> NEW INSTALLATION: IN septic tank or seepage,pit permifted if public sewer li available within 200 feet,) <br /> PACKAGE TREATMENT .[ ] SEPTIC TANK" .t Q.. :. Liquid Depth ........ <br /> .:. . <br /> Capacity t 0_Q._.... Type` '(4-:-� Moterlcd. .. No. Compartments .... ............. <br /> Distance to nearest: Well .....� ................Foundation .. ./P....... . Prop. Line ....... �.:�..... 0O <br /> LEACHING LINE No. of Lines Length of each line.....7.4............... Tato) Length <br /> I� a l p...........oQ <br /> D Box j:..... Type Filter}Material�:...... ..Depth Filter Material ............16.:............... ... oC <br /> Distance to nearest: Well . .D. :rF..... Fou atiort 71� '......... Property Line ......%T_0�..... <br /> ... Rack Filled Yes No <br /> ' SEEPAGE PIT [ 1 Depth _-. Dictrrteter � Number ❑ <br /> Water Table Depth ............r ...................................Rock Size ................................ 4' <br /> Distance to nearest: Well ........................ ..............Foundation .................... Pimp. Line ....... . ........... .t <br /> R1hAlR/ADDITION(Prov. Sanitation Permit# .........................._..._.......:.... Date ...:...............................) c <br /> Septic Tank (Specify Requirements) ' ...................................... <br /> Disposal Field (Specifyi Requirements) <br /> ----------------- --------------------- --------------------------------•-• .......................................... -••---• ...............................................................•---- <br /> = -------------------- -----------------------------••----- ......................................... ........I.......!- ..................................... <br /> �. 4 (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done M accordance with San J"idn <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.Olstrid. Hem* maw or Rem <br /> sed agents signature certifies the following: <br /> "I certify that In the performance of the work for which this permit is issued, I shall not employ any person in such manneel <br /> ` as to bec me suble o Workman's Co r+sation of California." <br /> f Signed . �I ... .. . �� <br /> F _.,�.. <br /> By ..................... ------------------------------ • title"_..._. ...................................... <br /> i (If other than owner) <br /> 4 f <br /> � FOR DEPARTMENT—USE ONVY <br /> APPLICATION ACCEPTED BY ..................... DATE ....J.L-��1 ...-... . = <br /> { BUILDING PERMIT ISSUED:.... ....:....... ....... • '-DATE - ..----------_ <br /> { ADDITIONAL COMMENTS ..------_- � �'- '=`I- -�.-, <br /> ----- --------- <br /> -----------------.........................................= <br /> ------------------------•-. .. -f�� cc-- . .--_...----... .......... ............ <br /> • ......... <br /> Final Inspection by: -•---------------------•--•---•___..........-----------............................. !y_':.- ------ ate ..-./ -z2-Z.�._..._..... ....._.... <br /> EH 13 24 1-68 1ev, 5M SAN JOAQUIN LOCAL HEALTH TRICT 8/74 31"1 <br /> _ _ I <br /> I <br />