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r T ; <br /> . FOR OFFICE USE-. -- <br /> APPLICATION FOR SANITATION PERMIT <br /> .................................................... IComplah In Tripl#catel Permit No. <br /> ............................... ....... ......... This Permit Expires!'Year From flesh Issued -Dote'lxsued : �,s?° ` <br /> Application is hereby made to the Son Joaquin Local Health Mitrict for a permit to construct and install the work hetaln <br /> described. This applitat[on is made in eampliar+ce�wit� County Ordinance Na. 5�t4 and existing Rules and Regulsrtions: <br /> Jab ADDRESS/LOCATI 1�.7 ......0 r�................CENSUS TRACT .. ............. <br /> Owner's Name ..... ,. C <br /> ..................�` z ............ ........phone .............�......._............. <br /> Address ............ r ,.. .. .....���� .. ...............................„... .. City . r..............................:.....»"................... <br /> Contractor's Name ....... !A�ti�'�:.�tr..{ .... l...r.�': -.License!li ./.. .�s ^~Pitons .............................. <br /> Installation will serve: Residence[Apartment HoustO Commercial Otroilw Court [3 <br /> Motel❑Other....l....................................._. <br /> Number of living units:..._.._... Number of bedrooms ... :Garbage Grinder ............ tit Slxe . <br /> Water Supply: Public System ant! name ..».................. ...�..»....... ........- ......�.. ................. ��y <br /> Character of soli to a depth of 3 feet: Sand t3 • Silt❑ , Clay 0" i�❑`--' Loam Gay D s �n <br /> Hardpan❑ Adobe o F#II 1iAtlthrlaf"...r...if yes,type............... ............. <br /> (Plot plan, showing size of lot, location of system In tbloltlon to wells, buildings,-otc,must be .placed on reverse side.] <br /> NEW INSTALLATION: (No septic tank or see ge pit penn*W if public sewer is-avallable within 200 feet,l <br /> PACKAGE TREATMENTSEPTIC TANK <br /> [ ] 3 3hjt... Ugvla.Depth .»r.r'�..'............,..». <br /> Capacity 19, . Type'AM-t-at-_ <br /> A Id...� No. Compartments ..... .... <br /> Distance to neorest: Well ::.Poun lativn. -rat ..... Prop. fine....514-e__ <br /> LEACHING LINE [Vfl No. of Lines ..-...... .......... Lsrq& of each ..... Total Length �!Er f ......... 1 <br /> 'D' Box ....I...... Type Filter Material .._.. r. s....Depth After 1 •........., x <br /> Distance to nearestc Weil .........4111... Foundation .... tt. ......... Property Line .....--+rd. » <br /> SEEPAGE PIT [ 4 Depth Diameter ................ Dumber ...........................- Rock Filled Yes ❑ No C) <br /> Water Table Depth ............»........................:.........hack Site..._......_.................... <br /> w Distance to nearest: Well ... ............................._:_:i"aundotiort ..... ..... Prop+ f.1ne --------------•---.--- <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ...... -777-7­ <br /> Date ...........».. .............�, <br /> Septic Tank {Specify Requirements?. ...- ... ._ <br /> ......... .........._.. ... _............ <br /> ............. ...........»..........................._..»... r- <br /> Disposal Field (Specify Requirements) ...........................................................................................................................:......... � <br /> ....................................­.............. <br /> exand requiredaddition.................................. <br /> ... . ddon reverse side) <br /> . ....... .. ... <br /> ............... ...._........ ............. <br /> (Draw ng _ . <br /> r ' <br /> I 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 Rales and Regulations of the San Joaquin Local Health.District. Herne awnsw or lken- <br /> sed agents signature certifies the following: <br /> "I certify that in the perFormance of the work for which tlds permit is issued, I shall not employ any person in such rnhotmer <br /> as to become subject to Workman's Compensation Iowa of California." <br /> Signed ---------...................._.._._.-.f. Owner <br /> By . . ......................................L.Fx-Yr _ _ xitle .. .'-x --- -. <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY_.._ :... . ................_........_.._................................-.-DATE .�.�- �P... ._ _...,........_. C- <br /> BUILDING PERMIT ISSUED ........................ ..................................._......._........_........_.........,DATE. .-............ <br /> ADDITIONALCOMMENTS..................................................................................................................................w.......................... <br /> '7 <br /> p ct on hy: ... +. <br /> ►- .................................... .....................[late.. j f -. ............. <br /> ,.. <br /> �3 �� �"� '• SAN JOAQUIN LOCAL HEALTH ©ISTRICT 8/74 3H <br />