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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT <br /> Permit No. ._�...-.._...1. . <br />......................................................... IComplete in Triplicates <br /> Date issued . 3°....... <br />_.......__.._ <br /> .............................. p <br /> This permit Ex iter 1 Year Front Dote Issued <br /> _._.._.....reby.-.,-•-e Ordinance No. t t and existing Rules and Regu1 <br /> Application is hereby made to she San Joaquin Local Health District fora permit to construct and install the work herein , <br /> described. This application is made in compliance with County ` ) <br /> N.....CENSUS TRAC .............. <br /> JOB ADDRESS/LOCATION ..: aS.d -/••--- ; <br /> Phone .................................... <br /> Owner's Name �lls ......•......................••-- -•--•-• ,... ` <br /> ... p- <br /> ....City .G,,S:C°��� -...._..--• --•----..........-......... <br /> Address . ,,thoa ......... ..........•-........... Phone -.- <br /> ._.Llcens # .3,117 �a .... <br /> Contractor's Name -- f�! y� e �JJ'' icra � <br /> "' �y�Hommercia '�`rgiler Court ❑ <br /> will serve: RMAnce Apa��nt} ousel] <br /> Installation , <br /> Motel ❑Other . <br /> r Garbage Grinder .. •- Lot Size ..... <br /> Number of livingunits:--,./ Number of'bedrooms ...----- <br /> R <br /> Water Supply: Public System and name ....... ....... .;. .......---•..._-------------•. ; ......... <br /> __.......__........_.......- <br /> Private <br /> y f <br /> Character of soil to a depth of 3 feet: Sand 0 51 .[.���Clay-©` Peat 0 Sandy Loam 0 Clay Loam ❑ <br />` Hard on� 0 Fill Material <br /> p Adobe ...if yes,type .................---....-... <br /> E <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 /> e? .._...... --•--. . Liquid Depth <br /> .�-SEPTIC TANK <br /> Size- ...... <br /> PACKAGE TREATMENT--�[_ � � �� <br /> Capacity -/��-------- TYpa��1,+�.�'��"aterial_..C�GNo. Comartments ..j..---- p <br /> g Foundation rop. Li .......... <br /> Line <br /> Distance.to nearest: Well -'�----"'--" ""•-" P � <br /> ' / Len th of each ine... <br /> 'i LEACHING LINE; [ No. of Lines ---- ---;-----•-• . g Tot <br /> ��/ / al Le�n/gth <br /> I 'p :g 'i._ MType Filter teria4�/y--'..7.•� �I�e.p#h Filter Material . 7-- -....... r 9 <br /> '�`" �,'d,•�+ pisfance to n a est:Mlle I ... Foundation e-7 -- ------ Property Line . .............J <br /> ox <br /> li _ RocFilled <br /> o I F <br /> :1 . --> —,,�`- � k Yes� No �] <br /> SEEPAGE PIT [ ] Deptfi .../fie J-----•... .CiarwMer'i� Numlasr _.. .....-•----- <br /> 1 -•--- ...Rock Size <br /> Water Table i3epth ! E...._ �.... <br /> t & ation <br /> ..........:.. Prop. <br /> Line <br /> DistancIe to nearest: Well .._--- ..Found <br /> r 4 <br /> REPAIR/ADDITION-(Prev. Sanitation Permit# ---- Date --•............. <br /> .......................................... <br /> . <br /> Septic Tank (SpecifEy Requiremc ents) ................... _. . <br /> Disposal Field (Specify. Requirements) -------------- ................. •---- ........----—...... <br /> ; , + <br /> --------------- - ­ <br /> ------- ------ ...................................... <br /> --------•-••-•-- -- <br /> ------- -- <br /> ------------------------------------------------------------- ----- -----•---- ---------.-------- .......................... <br /> _...:....._.. <br /> (Draw existing and required addition on reverse side) <br /> or will be din accordance with <br /> n Joaquin <br /> ne <br /> 1 hereby certify that I have prepared <br /> cation',�and Regulations that the w k <br /> of the Son Joaquin LocaloHealth.District. Ho a owner or I cen- <br /> County Ordinances, State Laws, and Rules and <br /> sed agents signature certifies the following: , .l person in such manna <br /> ' <br /> 111 certify that In the performance of the work for whichihis permit Is Issued, i shall not employ any p <br /> as to become subject to Workman's Compensation laws;of California." <br /> Signed) ; <br /> R Owner <br /> By ... ' 4 ---------- Title Q7�t . . /�•� <br /> ( <br /> tf other t a-n owner) <br /> FO EPARTMENT USE ONLY <br /> ' n ----.. DATE .�.. ..?�, ...................... <br /> APPLICATION ACCEPTED BY -•----- A <br /> _ .,... .�-- -----•----'Of --.---.... <br /> BUILDING PERMIT ISSUED _...-- ------ 3--= . . --------- -----•--------- --.----------- ... ---DATE ------------------------------ -._... <br /> ADDITIONAL COMMENTS ._ ��.,�'�.��.tt �"=-��•`- .���' --''•' <br /> -----.. --- -- .-._.-•--------------- ------.�.._..__------ <br /> J...................--------------- ------------ Date . <br /> f=inal Inspection b y = .......... i i <br /> EH 13 24 1-68 Rev. 5H SAN JOAQUIN LOCAL MEALTH'DISTRICT <br />