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# FOR OFFICE USE: A+ <br /> // al'PhcAnoNoR SANITATION PERMIT <br /> .......... .............................. s . <br /> (Complete in.TrlplicaM). .. ,. . Permit No. <br /> ......_.... . This Permit Expires I Year From Date Issued Date issued 1.!:.,? <br /> Application is hereby made to the San Joaquin local Health Disfrict for a permit to c_o_n triidf^and')ns#all the work herein <br /> described. This application is made in compli ncei with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION -.... <br /> ................ .............. <br /> Owner's Name -_....-..__... MU-4�_._ <br /> ...: .......................................... CENSUS <br /> TRACT .......................... <br /> -•••--.....----•-•-•-•-••-• •......................................Phone .. .....-----•-•-- <br /> Address ._. <br /> ...................City <br /> --- <br /> Contractor's Name _ �'//?� -�'_ ,��.--- !_V . "!�cl..:.....--•-----.License # ��5�1---- Phone <br /> r�....:�.�/.�II......_ <br /> Installation will serve: Residence[I Apartment Houser] Commercial❑Trailer.Court C] <br /> Motel ❑Other <br /> Number of fiving.unhs:-:_...- Number of bedrooms ...Garbage Grinder <br /> ..:...:..... Lot Size ........................................... <br /> Water Supply: Public System and name .._. ...Private ❑ <br /> ...---_.--o................�.-•----...........----•-..........------.. <br /> Character of soil too depth of 3 fe®t: Sand Ej Silt❑ Clay;-❑ Peat❑ 'Sondy Loam ❑ Clay Loam ❑ _ <br /> Hardpan p..Adobe❑ Fill Material ..._.........if yes,type.......:........ ............. <br /> (Plot plan, showing sire 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 sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [-] SEPTIC TANK ] Size.............. . ---..............._..... Liquid Depth .......................... <br /> Capacity -----}.___._ ..'Type ................ Material.................•:-•- No. Compartments _. 4 <br /> y r <br /> TEACH Foundation Prop. Line ............Distance.to .nearest• Well„_R.:.............••�----•--'-...... ----------------••-•-- -. ....:......__ <br /> TNG LINE D' BoxLin�s .-___ --•• -.-- ---.k:~Length`of each line..... e .f....:...-...__ Tota) Length .... ------------------ <br /> Box <br /> ----_-- -- <br /> [ � <br /> Type frlter Materpl .:f�A-/ 'Depth filter Materialle......... . ......:._. <br /> I 'l ............. Property Line .. •..- <br /> ,Distance to nearest: Well _..J�-�--............. Foundation _.. .. .k- ........ <br /> SEEPAGE PIT [ ( '-Depth -------------------- Diameter ......_._ ....... Number ............ :............ Rock Filled Yes ❑ No 0 <br /> « r <br /> Water Table Depth ........:..:...:.. <br /> •------------=----------------Rack Size ......:_..:....----....---•--•- <br /> Distance to nearest:`W&117_"_--­ :::: _:::::Found-#fan:"" °`� "`. Prop. fine ...............� :.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit .................... Date ...4...................... <br /> Septic Tank (Specify Requirements) -••--••--•----•-•-•-........................................................................................� ----• ., . ..- <br /> m .. <br /> Disposal Field '(Specify Requireriients) ..--••---------------------•-----•---....-------------.- ..-•-•--•--•--•-- -----••---._..............._.... ..._........ <br /> •-------------------------------------------------------------------------------- --------•-------- ........_.................. ....................................... ...............I................. <br /> I (Draw existing and required addition on.reverse side) <br /> Iihereby certify that I.have prepared this application and that the work will be done In accordance with Saes Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health;District. Home owner or licen- <br /> sed agents signature certifies the Following: <br /> "I certify that in the performancej"he work for which this permit is Issued, I shall not. employ any person in such manner <br /> as to becomeSubjectto Workmah's Compensation :laws of California." <br /> Signed -- -•-----•-•---------------•------- Owner . <br /> By -------•-------------------•-- - : Title ___.. - <br /> - --------------- <br /> (if other than owner) <br /> _ FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- ,r -`-�,_-_-- — •- <br /> - DATE... Z. Zr -...7 <br /> BUILDING Pi Rhi11T I55U1=D =-------------- DATE __.._.._..__... :_. <br /> i ADDITIONAL COMMENTS .............:... -- ---•..... - -.._.._. <br /> t ---------------- --------------- - ---------------- - ............... <br /> --------------- --...--------•----•--- -..-•----.:--•-•----- ---------------- ..........._.:........................... ...... ----••---- ......... ........... •--- <br /> -•----------• --------- -.-----•-•--•• 1---- ✓ .......... ...................., ------------ <br /> Final Inspection b ___--•i-- -- :. <br /> P y: .. ...............................Date _.... .�7 . .. . . ........ <br /> EH <br /> 13 2 1-68 v• ( JOAQUIN I:OCAt HEALTH DISTRICT 8/74 3M <br />