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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> . Permit Na. ��.�..:•/(••`-�-- <br /> .................................... (Complete in Triplicate) <br /> Da <br />..... te'issued ............:....... <br /> ..--• p <br /> This Permit Ex lies 1 Year frena Date Issued _ <br /> rein <br /> Application is hereby made to the tan Joaquin <br /> 4 witch aCo�DY ter mance ct for a Na 549 and exisrmit to ting Rules and tand all hRegul work <br /> described. This application Is madecompliance <br /> : <br /> � . '..;... ....: .r .r <br /> P. �.,........CENSUS TRACT ................:....:.... <br /> "JOB ADDRESSAOCATION ..—'`�---��- . <br /> Owner's Name .. ,L.�j...__..1. 2.4�.r.1✓..............:.................:............... Phone . ....... -.... ............._..: <br /> Address .....:..:. .. �.......�� /` ry.T. =. ....City . s <br /> � <br /> 19.1..73. Phone <br /> Contractor's Name ---- ��--T.���.�'�r,�s�. ..�••✓..�.._........License #' ,. <br /> iastallation will servo: Residence partment House <br /> Commerdal QTraller Court Q <br /> Motel Q Other"............................... Q__.1.�0.0...f <br /> 3-....Garbage Grinder .......:.... lot Slxe .._ .......... ' <br /> Number of livingunits: Number of bedrooms ... ..•. <br /> .............Private <br /> Water SuPPIY, <br /> ............. <br /> Public System and name .. .:.... <br /> I Character of soil to a depth of 3 fe®t: Sand E] Silt Q <br /> Clay CJ <br /> Peat❑ Sandy Loam.Q Ctay Loam �r <br /> Hardpan 0 Adobe Q Fill Material ............If Yes,type ...........:... ............ <br /> ot wing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse MCI <br /> (plIan, show t <br /> � <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted ff public sewer is available within 200 feet,l <br /> kEiquid Depth ..-5�,. .:............ <br /> PACKAGE TREATMENT [ SEPTIC TANK Size......:.. r..X.`............................ <br /> ,(Z ... T -erfST: '` ;........ No. Compartments ..... .. :...... <br /> Capacity yip Material. <br /> , r � <br /> k r .......Foundation _.,/P.............. Prop. Lime .. .......... <br /> Distance.to nearest: Well .......7't-5�.............. s <br /> Length a# each line/0:-/0-- ,5 -!e3'PataI Length J ............. <br /> LEACHING LINE [ No. of Lines ----�............: 9 <br /> .¢..Depth .filter Material 40 rr . <br /> 'Q' Box .'. Type Filter Material . .. <br /> I 1 <br /> Distance to nearest: Well .��----•-- <br /> ...._ Foundation �Q._...... Property Line .....+ .............. <br /> Number --...Q�.a .. Rock Filled Yes o 0 <br /> SEEPAGE [ ] Depth .�-�---..... Diameter Number ..,....---•-• <br /> Water Table Depth .• ..... ........ <br /> Q ....................Rock size .mayl�! ..... <br /> Distance to nearest: Well .... ••••....................... <br /> Foundation .....I.............. Prop. Line .._............,...... <br /> F ...---- Date .............................:.....� <br /> REPAtR/ADDITION#frau. Sanitation Permit# -. ..:.. ................ <br /> ........_ . ....... ­............... <br /> -- • ........................ <br /> Septic Tank (Specify Requirements)....................-- <br /> Disposal Field (Specify Requirements] -•.................................. .....•- .... <br /> ` :... "-....----•.................................................................... <br /> (Draw existing and required addition on reverse side). <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Jaagdln <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District. Hent* owner or liana <br /> sed agents signature certifies the following: person in such manner terrify that in the performance of the work .far which this permit is Issued, i shall not employ any pe <br /> as to becom blest to Workman's Compensation laws of California:" <br /> Signed -.... - /?.{e........................._ Owner <br /> F Title <br /> it a er than owner( <br /> FOR DEPARTMENT USE ONLY <br /> ----• .......-:....-..;_ <br /> APPLICATION ACCEPTED BY ---....-. F • <br /> BUILDING PERMIT ISSUED _..--• ----_------- ............. .. .........•---...........--•---- •-----•------ <br /> ADDITIONALCOMMENTS ---------.................................................................. • <br /> -------------------------------------------------•---------•--...-.-....-----•--------.-._....------•---------- --------•-.----------------- <br /> ---- •.-........-....... <br /> ----•.----•.....................••-.--•--..............---- ....---.....--- -•----... <br /> k - - - � ...-Date-.- <br /> .......... ....... .... .. ... . <br /> I:inal Inspection - - • ------ - <br /> .............••---- .....---..... . ..... <br /> EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 8/74 3M <br />