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APPLICATION FOR SANITATION PERMIT <br />. ......................................................... Permit No, .7G:..7 : <br /> ................................. <br /> (Complete in Triplicate) <br /> Date Issued ,V <br /> . This Penmlt 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 mod5 In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> .i � .JOB ADDRESS/LOC .. ..... ----•-----._�. .._.. �f--.... CENSUS TRACT ......................... <br /> 4 -' <br /> x � f�d <br /> Owner's Name .......... f ... .. ......._... .__......---Phone . .. . . .. .. <br /> F�ddress . ✓ t <br /> Contractor's Name _.._.. ....c��:�... ..!!.. ....... ...License �:� .'63Phone <br /> Installation will serves Residence tgApartment House t] Commercial E]Trollw Court I] <br />' Motel ❑Other ................................ <br /> Number of living units:--_.. Number of bedrooms ..,..Garbe a Grinder Lot Size .... ......... <br /> Water Supply= Public System and name ...: .. .:..-...-------------------•-_-...---_-----...................... ..............Private ❑ `l <br /> Character of soil to a depth'of 3 feet: Sand 0 Silt❑ Clay 0 { Peat❑ Sandy Loans ❑ day Loam ❑ <br /> Hardpan❑ Adobe 0 FIN Material ............ If yes,type............... ............ <br /> -!Plot plan;-showing size of_lot,-loZ'ation­of system in relation ta-welllid160-f,etc. um sf 69 Olivia on rave re side. <br /> NEW INSTALLATION: IN- septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK' Sizezr.k ."1/� .._ Liquid Depth .��......... <br /> Capacity .1.f�.024..... Type .................... Materialu+................_ No. Compartments .......�~------ <br /> r f4,- <br /> Distance <br /> ,,- <br /> Distance to nearest: Well ..1�. ..Faunpddatlan �� . Prop. Line � ...... <br /> -EACHING LINE: f4 No. of Lines ......L.............. - endfh of'each line....-D-no................ Total ten th . ....el?!e.."....... <br /> 'D' Box.... �...... Type Filter Materialr�`, _ ...Depth Filter Motor ...._�3............................... <br /> - Distance to nearest, Well . .. .� Foundation ...... 5�...... Property Line ......�.....r. <br /> . ........... . <br /> SEEPAGE PIT h4 Depth .-0,r.X....... Diameter :..:.: .... Number ..........0 .4. Rock Filler! Yes Mt No <br /> Water Table Depth ..... ..... ..................... .Rock Size ........Z:................... <br /> ZIP <br /> Distance to nearest: Well 0 ..........� .Foundation .....1 ZA Prop. Uno ..........:C�.�.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Data I <br /> aepticTank 1Speclfy Requirements( ...... ...............••.............. •---.........................._............................... ..........._................. . <br /> Disooso! Fiela,(Specify YRequirements) ................... -................:•.i's ......................................... <br /> (Draw existing and required addition on reverse side)} T <br /> t'hereby certify 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. Home owner of licen- <br /> sed agents signature certifies the following: <br /> "I certify that In $how of the war hic his ermit is issued, I shall not employ any person in such manner <br /> as to bec a sub arknt� 's Corn a tion la s f alifornia." <br /> ...anew..... .. .. .� .P. ...... _. ....... <br /> By ..... ............................ .............................. N ew <br /> litle ... ._... .... ............................... ? <br /> (If other than owner) <br /> FOR DEPART NT USE ONLY <br /> APPLICATION ACCEPTED BY ............... DATE <br /> -...........:..:..........: <br /> �'' .... <br /> BUILDING PERMIT ISSUED ," DATE-_ ............................... <br /> ADDITIONAL COMMENTS - --•...... ...... ................ .._----- -:-..., <br /> TF-i.. . r......... .. R <br /> w ........................................ <br /> ..i.--+L.. i I <br /> ._. ... _ _. -- --. .- _W _ <br /> ..... ............................ .... ........ .. ---._..._._....-....- ___•__....__•___.._...................--......... ... ...._.... __ <br /> Final Inspection by: _ ......................._....-..........Date . ... .. , <br /> EH 13 2!, 1•-613 Rev. 5MSAN JOAQWN LOCAL HEALTH DISTRICT 6/71t 3M <br /> j <br />