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1 <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT cS` <br /> Permit No. ........ <br /> ........................... . .. (Complete in Triplicate) <br /> Date Issued......A <br /> This Permit Expires 1 Year From Data issuer! <br /> uct and <br /> l the <br /> Application is hereby' ati neto the s admin cam lioncen Joaquin cwith Coual Health nty Ordinance permit <br /> 549 and existing Rulesic:lnd Regulations: <br /> described This app _ � l✓ b't�S-/,3fi� �� 2-- <br /> r--4.........dENSU5 TRACT ..................... <br /> JOB ADDRESS/LOCATION . _ . - . .......,. ...........,...,..< .. <br /> Owner's Nome . .,rZ ... ..... y Phone .........................> <br /> .-.-......-...... City ... ............. <br /> :y.•...............,...... <br /> Address _41 one ........................ <br /> ..� <br /> . e � J <br /> c License # J. --. Ph .... <br /> Contractor's Name _. ..��!�'---:�... ... • - .......... .. ....._,._...... <br /> installation will serve: Residence 0Aportment House's Commercial �7rts+#er Court Q <br /> MotelC]Other ............................................ <br /> Garbage Grinder . Lot Size!_ ..............._.... <br /> ........... <br /> Number of living units:.. ......... Number of bedrooms .. ...-.... .Private <br /> Water Supply: Public System and name ............................................................. <br /> Character of soil to a depth of 3 feet: Sand Silt£ j Clay Cy Peat C] Son Loam ] Clay Loam [] <br /> Hardpan[ Adobe 0 Fill Material ............ if yes,type........... <br /> to wells, buildings, etc, must be placed on reverse <br /> t (Plat plan, showing size of lot, location of, system in relation <br /> L <br /> NEW INSTALLATION, (No septic tank or seepage pit permitted if public sewer is available within 200 feet, <br /> £ � SEPTIC TANK Size._............................,,..............-.. <br /> Liquid Depth ` •,� <br /> PACKAGE TREATMENT I <br /> Material. No. Compartments ...:............... <br /> Capacity ....... ............ Type .................... <br /> .. ----..-•.•----•-•� i <br /> .Foundation ........ Prop. Line ............... <br /> Distance la nearest: Well...................................•- ........___._. ..,.._......._ ............................. <br /> No. of Lines Length of each line. <br /> Total Length <br /> LEACHING LINE ( � ` <br /> ' T Filter Material Depth Filter Material ...................................... Z <br /> 'D' box ......, .... Type .....,- � <br /> Foundation ........................ Property Line ....................... <br /> Distance to nearest: Well . <br /> Diameter C. <br /> Number ............................ Rock Filled Yes [3 No <br /> SEEPAGE PIT £ � Depth .. •--.�.."".` <br /> Water Table. Depth ................... .,...,«........,....,, ..Rock Size ..........»......... ca <br /> Well Foundation .................... Prop. Line ......... ......... <br /> Distance to nearest; ..._..,... .... .......�.. .......... .......» <br /> .. ..... <br /> Date --� <br /> REPAIR/ADDITION(Prey. Sanitation Permit t# ........ <br /> .. - <br /> ......... . ............................................_... <br /> Septic Tank (Specify Requirements) ........ ........ ......._.'y....�. ' .,....._....._, . <br /> Disposal Fie! (Specify Requirements) <br /> '" - „ l-✓ .. ..N . <br /> {moi .......... -�4... ... ........................... ............. »t <br /> .... .. • <br /> . ... . ..... <br /> (Draw exis.. ..ting and required addition on reverse side) <br /> ' <br /> will be dans in auordance withinn rra1tuln <br /> I hereby lith Dlstricfi.Hang owner oor Ilrttw <br /> certify that # have prepared this application and that the work <br /> County ordinances. State laws, and Rules and Regulations of the San Joaquin Local Heao <br /> F sed agents signature certifies the following: <br /> t 1 certify that in the performance of the work for which this Permit is issued, # xhaii not employ air person in such r»csnnw <br /> as to becomes subject to Workman*% Compensation laws of Callfornia." <br /> Signed Owner <br /> ✓ c r ,\ ` f ........................ itl8 . fr ,¢.c sraa..-.......,..._.... <br /> B <br /> llf other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> OATS_....... . ........... ................. <br /> APPLICATION ACCEPTED BY .............. .............. ......... ..................................... <br /> .`........_.......,.....DATE. , ............................. ....... <br /> BUILDING PERMIT ISSUED .........................I_ _..................... ............... . ... � ......_....,.... ..........._.,.................... <br /> ADDITIONAL COMMENTS .................,............. .........._.............................. .. ....... ...:...__ <br /> .......... ...........�...�,.....,........._.._...... ................................................._..:...........- .....:.,......" .. ,,.._.-.. <br /> ...................... Data ...... <br /> Finol Inspection bya ....... ...... .... ..................... .......... ...... <br /> ! SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> c u 13 24 1_,AA o.� �qm <br />