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rirK UVMCE USE.- <br /> ....... ............ ...........-1......­_.......... APPLICATION FOR SANITATION PERMIT <br /> ...... ...................................:...... (complete I" Triplicato) Permit No. <br /> ..........•••--•'•"'-"•' This Pernilt Expi Date Issued <br /> r9s I Your From Oaf*Issued ....... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct, and Install the work h <br /> described. This application Is made in compliance with County Ordinance Na. 549 and existing Rules and Regulationsteroin <br /> JOB ADDRESS/LOCATION ........45.7.4ig.. <br /> Owner's Name Q.Ap t ......CENSUS TRACT .......................... <br /> ................................ ........ ......Phone <br /> Address ...... d <br /> AX-4. ..... <br /> J <br /> ............................ .......... city ....... <br /> Contractor's.Name Ar.k.... ........... ............... <br /> ' ..... Phone will .. <br /> Residence -4rtment <br /> .... ................ ...... <br /> House f3 Commercial ElTraller Court C] <br /> Motel[:1 Other....... <br /> Number <br /> .......... -------**...... <br /> of living units:.. - Number of bedrooms _2.... <br /> W S _:­-Garbqge Grinder ............ Lot Size <br /> Water upply: Public system and name .............. <br /> Character of soil to a depth of 3 ............I................... .............................................Private <br /> feet. Sand L3 Silt —Cla— <br /> Hardpan ❑0 CIQY C3 Peat 0 Sandy Loa6j'C1_'_— _y_,Zaw <br /> Adobe 0 Fill M6twlol ............ if yes,typo ............... .... <br /> Mot Plan, showing size of lot, location of system In relation to wells, buildings, etc. must be Placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage it permitted If public Sewer is available within 200 feet,) <br /> PACKAGE TREATMENT I I SEPTIC TANK <br /> .. . <br /> .Size................................... <br /> Capacity .................... . ..... ....... Liquid Depth ............. ............. <br /> Type ----------------_- Material.__.... No. Compartments <br /> Distance.to nearest.. Well ................. <br /> LEACHING Foundation ...................... <br /> Prop. Line ...................... <br /> _G LINE N.o. of Lines .......... ............. Length of each line..-__- <br /> Box ............ Type Filter Material ...... Total Le�gth <br /> ......---•.................. <51 <br /> . _J <br /> ...................Depth Filter Material ........ ...........•....................... <br /> SEEPAGE D'StOnc6l* nearest, Well .... ....... ........... Foundation------------------- Property Line ........................ 00 <br /> PIT Depth ......... <br /> ........... Diameter ......... Nu'mber ............................. Rock Filled Yes [I No <br /> Water Table Depth7�� <br /> ...............................................Rock-Site..... <br /> 7................... ...... <br /> Distance to nearest. Well' ��;-- 11 <br /> ........................................Foundation ........I...... .... Prop. fine .................. <br /> 24PAWADDITION(Prev. Sanitation Permit# ............... Vk <br /> ............. Date _t.t:........ <br /> Septic Tank fSpecify Requirements)._.,........ .................. .................................. <br /> ------- ...... <br /> Disposal Field (Specify Requirements) <br /> ........... ....... .......... ....... <br /> ............ <br /> 000,.............. ✓ ------------ oL--dow <br /> ...... .. .. .. . .. . .........1�....4 ...........4w. <br /> -­------------------ ------------- <br /> ................. •---••---•.-....._•...................................1....._ <br /> lDrow existin ........................... ...... <br /> 9 and required addition on reverse side) <br /> I hereby certify that I have Prepared this application and that the work will- be clone in accordance with San Joaquin, <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local Health;District. Home owner <br /> sed agents signature certifies the following- or 11cen. <br /> "I Certify that In the Plu ormance of the work for which this permit <br /> as to become I Is Issued, 1 shall not employ any person In such manner <br /> me subject rkn'cn' Compensation laws of California." <br /> Signed ------ <br /> By .................•--....-..-_.../ . .. ... ........ ................ -------- ----------------­—--- Owner... <br /> ....... ......... -------------------- .................. <br /> (if other than owner) <br /> -..----•--•--• .Title ...... ................ ........ .......... <br /> R D PARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> FOR <br /> BY <br /> BUILDING PERMIT ISSUED ------- ------ .............. ........ ........ ....... DATE <br /> �R D PARTMENT IJIE_�N Y <br /> ........... ....... ....... <br /> ADDITIONAL COMMENTS ..-------•-----------------•----•-•....... --------------------------------------------------------- <br /> -------------------------DATE <br /> ................. ..............I.......................... ............... ........I..........-1......... <br /> .......................... .................................... ---- ....7................. <br /> ........ ........................I.................................... ..........­--------- .................. <br /> ......_------- -------­.............. .... --------------------•--....................---•--..........I......... ------­ ......... ..................I--------- <br /> -----------------_----•-...-.-............ ......... <br /> FinalInspection byo,-2. ........ -------------------••------------------------------------ <br /> ------------------ ...Date '..-..-...-•-.-----Y----- -­......... <br /> EH 13 22 1-68 Rev. 5M ....... . ....................................................... _....... <br /> JO,4 <br /> N JOAQUIN LOCAL HEALTH DISTRICT <br /> 8/7h 3M <br />