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4 <br /> FOR. OFFICE USE, r <br /> APPLICATION FOR SANITATION PERMIT <br /> .....�.;_...............�....I——..---:....I.............. p Triplicate) <br /> Permit No. 7.$.��:S' i <br /> " (Coen lets In Tri licate <br /> ......... ......................... This Permit Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the` on Joaquin Local Health District for a ;permit to;construct and install the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCAT ON U, L U S [ Av .....................CENSUS TRACT ............._.__.___-.--• ; <br /> Owner's Name _....-..... .�1 i ?C..2GeS'-............ •...................... ....:...... ...•--.Phone 2 4 �... 7,x. .2 `? <br /> Address ............... m ..............City ......• _ . _ - <br /> . <br /> Contractor's Name rw 6 Phone R4E��/ <br /> ------------ --••------••-•--------------•-••---------•---••-----.. .......License # = <br /> Installation will serve: Re idence❑Apartment House❑ Commercial❑Trailer Court ❑ F <br /> • <br /> it Motel ❑Other:---Mo IW e.....6an�e....... <br /> a s <br /> Number of living. units:............ Number of bedrooms .....--Garbo g -------..•--Grinder Lot Size --..��._....-•-- --......_..._..... <br /> Water Supply: Public System and name .................................................... ....__ .... [$ <br /> �r ...,._--------._.._. _.__... .---.... .----- .Private - <br /> Character of soil to a depth of 3 feeet: Sand 10 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay Loam ❑ <br /> Hardpan Q Adobe❑ Fill Material ............If yes,type.............. <br /> (Plot 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 sewer is available within 200 feet,) <br /> I I �f .. Uquid Depth Z <br /> PACKAGETREATMENT [ SEPTIC TANK S'eae.....:.......�... ...._.._..-------••---.. .:...----..... <br /> Capacity ------ Type _40)?< r Material-- a 'Ci �No. Compartments ....�L...---•-........ <br /> Distance. to nearest: Well � <br /> _... � .�00 .................Foundation b............. Prop. Line 2�. <br /> LEACHING LINE [ } No. of Lines ___._._._.._ g I. g <br /> ------...._. Len #h of each line...._._g®_....-........_ Total Length ...v .t d.............• <br /> 'D.' Box ....._-_... Type Filter Material ....................Depth Filter Material ..............-...----------•--•-- ......_. , <br /> Distance to nearest: Well .... . ... ....... Foundation .... .2......±.......... Property Lina ...Z.�'.� <br /> SEEPAGE PIT [ j Depth .....:.............. Diameter ........__:_=-_. Number ....... ........... <br /> Rack Filled Yes ❑ No 0 <br /> Water Table Depth --------.-Rock Size <br /> Distance t <br /> • o nearest: Well -----•..................................Foundation ----------........__ Prop. tine ...................... <br /> REPAIR ADDITION Prev. Sanitation)Permit t4!` -- --- ... ) <br /> / ( -----•------------- ----- -------- __ Date ....---•-•------..._...... -- - <br /> 3 <br /> Septic Tank (Specify Requirements) ...:.. .........--.....................................................:...........•---.................--.-..---••----•-...--------•- <br /> Disposal Field (Specify Requirements) --------_----------- --•--•------••-----.-.-------------------------•-------._..._..___...........----- -••--•--•----- ---...... .. <br /> .....................................................•..................._....._..-• .............................. •------------- ---- --- ............................... <br /> I <br /> --------------•-•--•--. -------.._--------------------------------------------- ------...._._...------------•----....•----••-•---•-•-•........._.._.---•-------------- -----_---......----------•--- <br /> (Draw existing and required addition on reverse side) a- - -�--- - - � <br /> -1 hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and 'Regulations of the San Joaquin Local Health:Dlstrict. Hoene owner or Iieem <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> as to became subject to Workman's Compensation laws of California." - <br /> Signed _- Owner <br /> yy <br /> BY ........ !- ''" ....... ... ....................... ............ Title , <br /> ............... <br /> Of other than owner) <br /> O EPA MEN1t UX ONLY <br /> APPLICATION ACCEPTED BY ---------- ---- Ll'--- ---- --- ------ - ----------------------------- DATE .,_.._ .. ...:__..__�'_..._.........- <br /> -- <br /> BUILDING PERMIT ISSUED ------ - ..?.-------•-�•-•--•-•-- ---------------------------------DATE ---- -- ----------.._. .-._ _. ._ <br /> ADDITIONALCOMMENTS --------------------------------------------- ----- --- ----------------•--_ •-•--••-- -----------... <br /> I ................................. - Si _..-----------------.._...-. -------- . .........._...._.._._.............._.._.. <br /> I - <br /> ----------------------•----•---- --_--- .--.-_.._L I. .......... ..............................._.....- •--•-•------- - --...---........ (� <br /> Final Inspection b . ------•- .................I'll............Date d r ......... <br /> l Edi 13 2a 1-68 l SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h3M <br />