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FOR OFFICE USE: i <br /> APPLICATION FOR SANITATION PERMIT <br /> -76_Zs <br /> (Complete in Triplicate) <br /> Permit No. .................. .. .. <br /> -..............._.._..:............................... r Date Issued../..!� :. � <br /> ............. This PorrnI Expires 1 Year From Date Issued <br /> Application Is hereby made to the San Joaquin Local Health Distrlct for a permit to constrict and Install the work herein <br /> described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulatlonst <br /> '! -•--' ..ti,� '._ r '+Mrs-moi�„r y - <br /> i �Lj <br /> JOB ADDRESS/) ON ..... �..p��.��. ..�� ............ ...... ........ .....-..................................CENSUS TRACT . <br /> Owner's Name}..._ I .. Ct.: Sal..). ........ ... l - . ............................Phone ..�.. ...... . _ . ..... <br /> �_ --I _ <br /> Address ... - 1- ---------- ----- 1, •--- ......--------•--...... .......City . . �/. 1?�fcG ..........---•--••...................... <br /> 1._ p... .._.. g <br /> Contractor's Name . �...:........:........:..:.3:::_.._:Llaen�e # ._. Phone.!-..��....__-.. <br /> Installation will aervm Residence's Apartment House❑ Commercial❑Trailer Court ❑ <br /> Motel❑Otho►... ..... .:.:............. <br /> Number of living units:. ./...... Number of bedrooms ...iGarbogo Grinder .............Lot Sizs._ ..................... <br /> Water Supply: Pudic System and name. . -- ........................_...................._.......................................------......Private <br /> Character of soil to a depth of 3 feet: Sand b. ,Silt❑ Clay- 0�Peat❑ Sandy Loam Gay Loam ❑ <br /> Hardpan© Adobe O� Fill Material.... ......If yes.type............... ............ l <br /> (Plot plan, showing size of lot, location of.system in relation to wells, buildings.iitc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage Olt permitted if public sewer Is available within 3004eet,) <br /> PACKAGE TREATMENT J.] SEPTIC TANK 1 ] ' Size... f ' ti�. ....:............ Liquid Depth ... .............� <br /> Capacity���` rtYpe,e . �!Z.Materlal............... . ... No. Compartments ..�......... <br /> Distance to nearest: Well -P7.. ..................Foundation ./!2.............. Prop.'ltns. <br /> EACHING LINE ( ] No. of Une: .:a ... .......... length of each�llne� . �'............... Total length. s ��............ {�1 <br /> 'D' Box ...../'~ Tyj s.Filter.Materia! ,�,�, .u.�,��epth Filter Material . ., . �......... , ........ .; <br /> „ <br /> -Distance to aoresh Well r'hl--V.... --....... Foundation .......... Property line ,la.......... .... <br /> SEEP Depth .. '...........`.. Diameter .. ....... Number ............ ................ Rack Filled; "Yes ❑ No ❑ <br /> �'--•. .Wafer Table..Depth .---•-• ......................Rock.Size ............... ................ <br /> Distance to nearest, Well .__......_....... ................ <br /> ..............1... .FowWatlon ............I. ...... Prop. Line ........ ..........� <br /> REPAIR/ADDITION(Prov. Sanitation Permit#=.........................................*-. Date ......... ...........`..........I <br /> SepticTank (Specify Requirements(.............. ......... ....... ..... ................ F .................................._-................ <br /> Disoosal Field (Specify Requirements) •.......................................:......:....I................................. .......------.......----......... <br /> .................................................................................... .... ......................I............. ..... <br /> ..................I........-............................................................ .................................. ................................................... <br /> (Draw existing and required addition on reverse side). �++ <br /> I hereby cortily that I have prepared this application and that the work will be dens In accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or licen• <br /> sed agents signature-certif arthe-foffowing--- — .- — - --_,:-_ . -- - - , - - __4 <br /> "°I certify that in the performance of the work for which this permit is Issued. I shall not employ any person in such manner <br /> as to become subject to or an's Compensation laws of California." <br /> Signed ....--- r. .. .k... ......................................... Owner <br /> _- lisle . <br /> Jif other than owner( <br /> FOR DEPAR ENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> DATE .. I ..:. <br /> BUILDING PERMIT ISSUED .........DATE-........ ...... T. <br /> ADDITIONAL COMMENTS ---•--••• ... <br /> _ <br /> ................................... .................. ........................... ........................ <br /> .................. ... <br /> :... ..... .� <br /> Final Inspection b ----•........................ -----.................Date -. f <br /> EH 13 2h 1-6f1 53�t SAN JO QUIN LOCAL HEALTH DISTRICT 8�7h 3M ,r <br />