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r"" "M" "ter` APPLICATION FOR SANITATION PERMIT <br /> Permit No. 76- 733 <br /> lComplete in Triplicate) <br /> """'""""'"""' <br /> .... ..... ............................................ <br /> ... This Permit Expires I Year From Date Issued Dab Issued <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 made In compliance with County Ordinance No. 549 and existing Rules and Regulations <br /> JOB ADDRESS <br /> AOC.ffN ���. /r/. . . ....x'1. .4- :. ... . CENSUS TRACT .......................... ' <br /> Owner's Name ..pal 'l!. . . .... ......... .............. ... ............... .................... <br /> fkddress1l�scxs,.. �?.. ...............................Cihl .......................................... <br /> Contractor's Name .. _ ..License # AZ��AZ_ Phone I.....I...................... <br /> installation will serves Residence Apartment House[] Commercial❑Troller Court ❑ <br /> Motel ❑Other <br /> Number of living units.-_/ Number of bedroom& .jo!;7 Garbage Grinder ............ Lot Size ................................. <br /> Water Supply: Public System and name ------- .....................-----------------------_..................................................Private <br /> Character of soil to a depth of 3 Teets Sand❑ Silt❑ Clay (:3 Peat)W Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan❑ 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 sijy v <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted If ublic sewer is available within 200 feet,) <br /> i <br /> PACKAGE TREATMENT [ } SEPTIC TANK�� Size........la�.x��?.... .............. Liquid Depth ....��. ....-•-........ <br /> Capacity .�pZ4.V..... TypeV 4 .... Material ........ No. Compartments ..�............. <br /> R .. <br /> Distance to nearest: Well' _.%5.Q............................Foundation .,/ . Prop. Line s� <br /> BEACHING LINE [ir No. of Lines ........................ Length of eachIine............................ Total Length ............ <br /> 010 <br /> 'D' Box ............ Type Filter Material ..Daptfi. Filtbr Material ......., X......................... <br /> - Distance to nearests Well ...J..a .. Foundation K.;%4............. Property Line <br /> SEEPAGE PIT [ ) Depth .................... Diameter ............. . Number ............................ Rock Filled Yes ❑ No <br /> Water Table Depth ........'........:..............................Rock Size ................................ <br /> Distance to nearests Well ........................................Foundation .................... Prop. line ----------•-------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............................................ Date ....................--------......I <br /> SepticTank ISpecify Requirements) ......................................... •-•-......------............................................._ ..........._.......... <br /> ,Disposal Field (Specify Requirements) ..` .....A �'L�:Gam.... ��r L!n!C—�...FXt.ST/.nl C— S�ST�N1 ,...... <br /> .................................. --•.............•----------------------------------•----•-•-............-•---...........................-----•-----................................... <br /> (Draw existing and required addition on reverse sidel <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Jeaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcon- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is Issued, I shall not employ any person In such manner <br /> as to be o su lett t ark n's Compensation laws of California." <br /> .fined ..... ....... .... . Owner <br /> By ..... ........ �"ther&' . . title .... . .i........................... ....... <br /> an owns <br /> R DEPART NT !!P, ONLY <br /> APPLICATION ACCEPTED S - - <br /> ... DATE "•'� <br /> BUILDING PERMIT ISSUED ....---.. ......•-•---.................. ......................................................DATIr-..........-............-............ <br /> ....-.. <br /> ADDITIONALCOMMENTS .... ....................................... .............................................................................................. ............. <br /> .. .. .. . . . <br /> .... . r . <br /> G . <br /> ob . .Date ... ....... ... ---......... <br /> Final Inspectin <br /> LH <br /> 13 21,E 1-68 nev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h _ 34 <br />