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A <br /> FOR OFFICE USE: <br /> OFFICE USE: .�APPLICATION FOR SANITATION PERMIT <br /> Permit-No:_,7v---S <br /> --------------------- �.. .... ... <br /> - ------------ <br /> (Compi <br /> ete in Triiplieatel <br /> .............. <br /> t 1- 1 Date Issued --¢------- <br /> Permit Expires I Year From Date issued <br /> ------------- <br />---------------- ------------------------ <br /> trict for a permit to construct and install the �Vork herein <br /> Application is hereby made toftRe San Joaquin Local Health Dis ' 5A9 and existing Rules and Regulations. <br /> deschbed. This application is m'dde i in compliance with County ordinance No TRACT ------0--- <br /> ------- <br /> --------------------------..CENSUS TRI -------0--- ----------- <br /> J ADDRESS/LOCATION _'m__ .__ -A ---------Phone -457--------- <br /> r ...................... ------------------------ <br /> OBI <br /> Ow e s, Name <br /> 1 city --------------------------_ <br /> cit <br /> L <br /> ---------- <br /> Address ----;Pf <br /> License # / 4 5 Phone <br /> Contractor's Name <br /> Installation will serve 'Residence;gApartment House❑ Commercial FITrailet Court <br /> Mot <br /> Number of living units:__lel F-l Other ---- --------------------------------------- <br /> bedrooms __7-----Garbage Grinder ------------ ------------------ <br /> -- Lot Size -------------- -- <br /> - - Number of bedro I <br /> I I I & Priv to ❑ <br /> water Supply: Public System and <br /> Silt F Cloy Sandy Loom 0 Clay-Loam.D <br /> a San 'Peat El <br /> Ch racter of soil to a deoth of 3 feet. Sa I <br /> Hardpan EJ Adobe)K Fill M'Oterial ------------ If yes, type -------- ------- <br /> (Plot plan, showing size of lot, - <br /> location'of system in r1lation to wells, buildings, etc. must be placed on reverse side.) <br /> NEWINSTALLATION- (No septic tank or seepog6 pit permitted if public sewer.is available within 200 feet,) - -------------- <br /> PAC�AGE TREATMENT 1 1 SEPTIC TANK f ------------------------------------------ Liquid Depth ... t�_. <br /> nts --I-� •.......... . <br /> Capacity _-- --------------- Type 1�t Material---------------------- No. Compartments ----- <br /> F-i p. Line ------------- <br /> In- Pro <br /> Distance to nearest: Well ------------ <br /> .0 11 ------- otal Length -------- -.----• <br /> ----------- <br /> nes ------ -------- Len1gth Of'�O�ch lirlv�_P' -- ---- <br /> LEACHING LINE No. 0 U ----------- <br /> erial ------__----_--------I------ ---- <br /> 'D' Box Type Filter Material -------- Depth Filter Mat <br /> i 1 1 1.1 11--------------- Property Line ---- -------------• <br /> Distance to nearest: Wel ------------ Foundation --------- <br /> I - !Numb4l ----- --------------------- Rock Filled Yes 0 No 0 <br /> SEEPAGE PIT Depth --------------- Diameter -1------------- <br /> ----------Rock Size ------------------------------ <br /> -- <br /> Water Table Depth -------------------------------------- I i I <br /> 1 1 --- -foundation Prop. Line ----------- ---------- <br /> I <br /> Distance to 11 ------- I <br /> i ' I I -_ Date ---------------------------------- <br /> REP (Prey. Sanitatio Permit# ----------------------------- <br /> R/ADDITION I— � I <br /> -----------1-1----- ------------------------ <br /> ------------- ------------(777 1 ------ --- ----------- <br /> 4'�- ----------------0 <br /> Se tic Tank (Specify Requirements)p C ------- <br /> Disposal Field (Specify Re! ment .... .. <br /> quire ------- <br /> Y' 451-' ;oe ------------------ ------------------- <br /> ---- ------- <br /> 'e <br /> --------------------------- --------- --------------------------------------------------------- --------- ------- ------------ <br /> (Draw existing and required addition dn reverse side) <br /> the/rorlk'l Will be done in accordance with San Joaquin <br /> I hereby certify that I have Jrepired this application and thatI I - <br /> t 6 in Local Health District. Home owner or licen <br /> County Ordinances, State Laws, and Rules and Regulati ions of the S6n Jodqu <br /> sed agents signature certifies lhe-followinq:— in tuch manner <br /> this permit/is issued, I shall viol ernplo� any person <br /> "I certify that in the performanceT'of the work for which S <br /> 14 C <br /> as to'become subject to Workma�,s Compensation laws of California.a <br /> ...... .... <br /> laws "Oil <br /> ----- Owne� <br /> .......... ------ <br /> Owne�, <br /> Signed ---------------------- -------- --- --------------------------------- I I <br /> Title --- --------- --------------------- <br /> -- - - ----- -------A <br /> By . 21 4 i <br /> - -------------------- ------------------------------- - <br /> (If other than owner)rl <br /> FOR DEPARTMENT USE ONLY <br /> ATE --- -------- <br /> m- � ---------------------------------------------------------------------------- --------- 1 <br /> --------------- <br /> A�,PPLICATION ACCEPTED -DATE --- <br /> BUILDING I , P IT S U <br /> 'r, F:pm S <br /> BUILDING PERMIT ISSUE ------ -1-- ------------------------------------------------- ------- <br /> D -- -------------------- <br /> ADDiTiONALCOMMENTS ---------- -- ---------------------------------------------------------------------------------------- <br /> 1 ------- 7----------------------------------- ------------------- ------------------------------------------------------------------------------------- <br /> - -------------------- ----------------- ------------------------I -E--------------- ---I -------------------------- --------------------------------------------------- -- --------- -------------------- -------i-----------i------- <br /> ---------------_------------ ----------------------------------------------- -2. 0 <br /> Date --------- ---------- <br /> ---- ----------------- -- --------------- - -- <br /> Final --- ----- --------------------------------- ---------- <br /> - .- e ---------- <br /> iInspection by: ---- ----------- ----- -------- --------------------------------------- <br /> SAN_JOAQUIIv_IOCAL_HEALTH <br /> E. H. 9 1-'68 Rev. 5M <br />