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<br /> FOR OFFICE USEAPPLICATION FOR SANITATION PERMIT
<br /> 3- X71
<br /> -. _-.... ..............:... ...
<br /> ........... Permit No. . ..
<br /> (Complete in Triplicate)
<br /> -IB—73
<br /> Date Issued
<br /> This Permit Expires i Year From bate Issued .. .. .. .......
<br /> Application is hereby mode to the Son Joaquin Local Wealth District for a permit to construct and install the work herein,
<br /> described. This application is made in compliances( with County Ordinance No. 5A9 and existing Rules and Regulations:
<br /> JL?B ADDRESS/LOCA pN .. _�.'�rt ._ ....fir.......-r'``'1 ? -max. .�._f ' ,......CENSUS TRACT ___.s� ........._,..
<br /> OwnersName ............. ........... ..Phone .......................»..........
<br /> Address _ ._.. .,: .,.._. .,.City ...�r ....�.....,................... ....»......».....
<br /> Contractor's Name ...._. a,
<br /> -7 - _...License # .... ..........
<br /> id n�+rsrtrnent i souse Commercial:"Trailer Court Q
<br /> Installation will serve: Res a Cp `❑ L_.I
<br /> Motel ❑Other ... ............_ _. .......
<br /> Number of living•units: -t... Number of bedrooms ...Garbage Grinder ............. Lot Size ......_......-._._:_..,a........-...........
<br /> Water Supply: Public System and name ...................,_.........._......_...._...,,.,,...._...__...,...
<br /> ....,,....................................Private,
<br /> Character of soil to a depth of 3 feet: x Sand'❑ Silt o Clay ❑ Peat❑ Sandy Loam •❑ Clay Loom ❑
<br /> Hardpan Adobe ❑ Fill Material .._- if yes,type ........-,
<br /> IPl'ot 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 pit permitted if public sew r is ovally le within 200 feet,) i
<br /> >
<br /> Liquid LI Depth .._ .._.
<br /> PAC<AGE TREATMENT f ] SEPTIC TANK Size_ q
<br /> Capacity tL<S.O._ 3. Type •-L?..- Mo erial- ..._ ._ No. Compartments .......
<br /> Distance to nee est: Well 5a_ ----------------foundation 1.0.. . .....; Prop~Line__... ,..:........
<br /> LEACHING LINE ( No. of Lines _ . Length of each
<br /> 'D` Box _1....... Type Filter Material ....... .....Depth alter Material --'......... ............................•-
<br /> 1 �
<br /> Distance-to nearest: Well_ Foundation JD_ Property..Line .. ................±
<br /> SEEPAGE PIT ( Depth -. ,. ..i Diameter ,.. ..3. Number :----.-... Rock fillers Yes J' No C
<br /> -.........Rock Size _..�'rt9..... '.
<br /> Water Table Depth ................�►�tJ. �....._---- . _ .)C.....-._.._._. r
<br /> r
<br /> Distance to nearest: Well ._.................� ? . .. ......._Foundation;'--l-O...........
<br /> oundation�_--fl..........,... Prop. Line .._.. ............
<br /> REPAIR/ADDITION(Prev. Sanitation Permit# .............................. .. .. Date ........................
<br /> Septic Tank (Specify Requirements) .....................................»............_._.......,........ .!-............................. .........
<br /> Disposal Field (Specify Requirements) ....... .............<,... ..- ,....__..........,. .......-.�--�-- .... ..........................
<br /> r
<br /> _......................,...............,...................... ._...................._......_..w.. ....._. i. ...... ....... ......................_.............._.,..w.........
<br /> ..., .. ..
<br /> .............................._....................... ,....................................._._.............. .............,........_..........._......._........ ......._...........
<br /> (Draw existing and required addition on reverse side) , r
<br /> t hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin
<br /> l County Ordinances, State laws, and Rules and Regulations of the Son Joaquin local Health District, Hame owner or, licen-
<br /> sed agents signature certifies the following:
<br /> "I cprtify that in the performance of tho worse for which this permit is issued, I shall not employ any person in such manne+
<br /> as to become subject to Workman' Compensation laws of California,"
<br /> Signed-.... :_. ..._...-..,._... .,. W. .._ .. Owner
<br /> ............... title �. . .._,.... ..........._ _. ......-._..... .._.. ....
<br /> (if other than owner}
<br /> ,�. FOR DEPARTMENT USE ONLY
<br /> APPLICATION ACCEPTED BY... ... . . .. .............. DATE ..•...'....•»
<br /> BUILDING PERMIT ISSUED ........................................................................................,..............DATE ...................,....................
<br /> ..
<br /> ADDITIONALCOMMENTS . ......... .........._................... ........;...._....._.___...,................................ ....._............,.._,.,,�.,..,.....».»,, ..
<br /> .......... ...
<br /> ;; ,..._......,,....._. -.. ...... ...................._......... ..._ ..................._....-..........................
<br /> ' ....-
<br /> Date ..`... :.
<br /> Final.lnspection by: !"�k'1� ._. --------------- _............ ,._...
<br /> SAN JOAQUIN LOCAL HEALTH DISTRICT
<br /> E. H 9 1-'b8 Rev. 5M
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