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- FOR OFFI'ti+F.USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. . y <br /> r� ........................................ r,. (Complete in Triplicate) <br /> ........................................................... . <br /> ed <br /> f � Date�lssu .S-.S-•;��. <br />• This Permit Expires t Year From Dale Issued <br /> ............................... <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and install the work herein <br /> described. This application is rriade In compliance with County Ordinance No. 549 and existing Rules and Regulationss <br /> 'l. -.. G. . ................CENSUS TRACT <br /> ...... <br /> JOB ADDRESS/LOCATION, ........ . /.. . <br /> r _ n � <br /> Owner's Name:. -- .G°.� �/._.....!�..�l.W.5 –... ....... .......Phone C� ..���✓' :4 ...... <br /> Address . .: a. ... .�.-..1 #c.: .T ! '. .. ...._...tractorCi <br /> city ..Tt '. .............?.. <br /> - 77- <br /> Contractors Nam ...._._ ,:. �: !/L.-. 12.w... :.. • �" license .J�-'j...�.. Phone . .. <br /> Installation will serve: Residence-•Apartment House] Commercial QTrailer Court <br /> # Motel ❑Other ( /.... : AC <br /> ......... ..... <br /> ....................-----...... <br /> 11 <br /> Number of living. un'its:...-.I_...... Number of Sedrooms_04_—_ .G+trbage Grinder Lac 5#ae ... .. ... <br /> { Water Supply: Public System and name ....................................'- ...................._........................ <br /> ....................:...l...Prlvate <br /> 4 Character of soil to a depth of 3 feet: SandE] Slit[3 Clay Q Peat Q Sandy Loch► p Clay Loam <br /> +E. Hardpan~Q Adobe Q fill Material ............ if yes,type............:.. .... <br /> # (Plot plan, showing size of 'tot, 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 TANIG II } Size..............i................................. Luluid Depth ....---...................V. <br /> � ..--... Mo <br /> terii .. . -----._.._..... N9o <br /> . Compartments ................... <br /> ...syCapa ify - Type .... f <br /> Welt ............ .-:Foundation .......---....._ Prop. Una ....................to/nearest: <br /> LEACHING LINE No. of Lines ... .Length of each line................ : Total Length ............................ <br /> Depth .Fitter Material <br /> 'D' Box ...... Type`Filter Material ..... Dep ............................................N <br /> ..... Foundation ........................ <br /> Distance to,nearest: Well``:. T j r :; Proper#y Line <br /> _ <br /> Rock,Filled Yea No <br /> SEEPAGE PIT ( ( � Depth ......`:... ..__. 'I3lacx�eler __ .....----•-- Number ....--- 0 <br /> C <br /> Water abled'l epth - ........ +.............Rock Size .-. .'.. a y ...... ......:..:... <br /> i I t Distance-to nearest:Well,---•--•--------• -�-........I...Foundation ..................... Prop. Line [` <br /> ......._.REPAIR/AODITION(Preu. Sanitation Permit _ Date f <br /> } <br /> i <br /> Septic Tank (Specify Requirements)............................. .. ...................................................... .. ............ ..... .._.............. <br /> s <br /> Disposal Field (Specify Requirements) ..... Vk <br /> - <br /> f ......................................................•............_.... ' - <br /> �ji <br /> '14 (Draw existing-and required addition on.reverse side) <br /> t 1 hereby certify that I Lve,prepured this application and that the work will .be done_Gln"attordanii with San Jsappin <br /> } County Ordinances, Stgte Laws,.and Rules and Regulations of the S4Joaquin Local Health,District. Horne owner or lian- <br /> sed agents signature ceiiifies the fo'liawInge <br /> "I certify that in the performance of the work for which this.permit is issued; Vsholl not employ any person In such manner <br /> as to become subject ` Wor an's ompensation laws of Californla:" <br /> I <br /> ........................... ... Owner <br /> w '....... t .��.-' "._ :..Title ............................................ . ............. <br /> (If other than owners <br /> FOR DEPARTMENT USE ONLY <br /> 29 <br /> APPLICATION ACCEPTED BY ..... . . ....................................... <br /> ---------"--_-----•------------------- ........ <br /> ----...-----.. . , DATE ,.;:.,.. .. �'? -,�G.-.......... <br /> $UI:LDING PERMIT ISSUED --------7------------------ -- ---.....................DATE .:......................................... <br /> ADDITIONAL COMMENTS ----------------------------- - <br /> I ............... ---....... --...._............------. -----------------•---•--- <br /> ......---•--.- ............... !.......... ................................ ............................ . ............... <br /> ..............................y: .......... .-' .._ ------- ------- --------- <br /> •-------------• . . -• ate .... ,,?C�. ..., �1-........ <br /> Final Inspection b C/�-------------------------------------------------------------- --• <br /> EH 13 2L 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M <br /> F • <br />