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FOR OFFICE USE: <br /> 11 APPLICATftW-FOR SANITATION PERMIT <br /> ..............�r............­..................... Permit No. <br /> ..fComploteinTripliciate) <br /> ......................... .................... <br /> Date <br /> ........ ..................... This:Permit Expires I Year From Date Issued <br /> Application is hereby made,to the Son Joaquin-1.6cal,Health Districtfor a permit to construct and install the work herein <br /> described. This application is'-made,in cc. . r wiih County,-OiFdinance Nor 549 and existing Rules and Regulations: <br /> jorfir M Kilnl dy Ave French <br /> .CENSUS TRACT ...... <br /> B ADDRESS/LOCATION I--�..!Q��9��4XM,=............ ................... Cam n <br /> ............... <br /> -Owner's Name ...... ................--."-T--.--.... Phone ..4.63-.308-x--------:--- <br /> 1116. So Cresc6nt ,,St`_reet' j LOdi <br /> Address-.................... .•--•--i.-_,....-"-----..-:.- ------ ........­­ -••-•---. ......... .......... ...... ...... ..................... <br /> .... .. ........._License # ...................... .........I.....-----..... <br /> Contractor's Name -------- ------------------- ........... <br /> Residence C]'Aportment-House Commericial Guest <br /> 'Installation will serve: Statelicensed home for 30 matients <br /> kl <br /> Motel 0 Other-----------!......I——...................... <br /> 161 <br /> Number 0;�iving units:.._......--- Numbdr of' bedrooms -----------Garbo'ge Grinder ...49.`'`Lcrt Size .. ................ <br /> and nam .................... <br /> Water Supp! . Public System ..........L ........... Private <br /> .......... <br /> Character of soil to a depth.of 3 feet: Sand 0�SIlt El Fla-Y, b. '_..Pgait'. Sandy Loom. Clay Loam-0. <br /> if yes,type...... ........ ............ <br /> t" <br /> A <br /> Hardpan C] " Dbe.0 Fill 0 <br /> I <br /> lot, location relation Itcir`wells' 6upildings, etc. must be placed -on reverse side.) <br /> (Plot plan, wing size of otsystem,'in r' I- <br /> Ill _.2 t rihil <br /> NEW INSTALLATION: (No septic tank or seepage pi tted J.Jw#lic sewer is available within 200 feet,) <br /> 1,0,t d'.2 <br /> Depth ................... <br /> PACKAGE TREATMENT SEPTICTAN[Kf ... . ..Zp....................... Liquid Dep <br /> 1 0 <br /> Type 400., `.�n <br /> a' jaj_'Y�Wr? --- No. Compartments <br /> ............. ter <br /> of <br /> D19tance <br /> .......... <br /> ou ............. in <br /> 40 ni�6ibsti.,Well ----..1.5;x_,....._...0 dation Prop. Le...........F � n <br /> Lines .......... ........... Total Length ............. <br /> LEACHING LI.NE j I Nal t��:,df Li-es Length",of eac;h li.ne <br /> ........... <br /> D, ox ..Camerl-Vpe Filter Material Material ...... ......... <br /> Property <br /> Distance tij-2092-_n7�.- Foundation . .-A -A.......... <br /> to nearest: We ------- <br /> No C) <br /> 9_�E PIT Diameter -C.X� -Number ------- Rock Filled Yes-4 <br /> SEE Depth <br /> r <br /> :_.bock size -76 <br /> WatertToble-Depth ......... !:�O� <br /> .'.Foundation -2.474!............ ......... <br /> Distance to nearest: Well .. .. ........ .............I... . <br /> Sa�itation Permit# ---------- <br /> REPAIR)ADDITION(Prev. ---------- -------------- Date --------- ........................... <br /> V. <br /> A.......... .. ....... .................................... ....... <br /> Septic Tank (Specify RecItiirements) -------------n_--------•-- -— ...... <br /> Tl�o Additi nb.1\Le.a:ch Lines. Each ljSDe to ...... <br /> ............... <br /> Disposal F�elcl (Specify Requirements) ------ -----------------------0............................... ............... ........................... <br /> be---100-I..-, <br /> ,�Jang...with--a pi.t_at__'the----end_o -e W)- --- <br /> `�6stea. <br /> and tOn ......----------- ......4................................. ........ ............................... <br /> pet debp filled with gravel, as requested. <br /> .................. ------- --- ------------ - - ----------j---------- <br /> ---------- <br /> (Draw existing and required addition onreverse,side) <br /> 'I hereby certify thc_vlhavW!f jjpared this`a_ pplicat'ion—a-nd that <br /> the w—ork w <br /> ill"le done In ,accordance with San Joaquin <br /> n <br /> County Ordinances, State Laws, and RuIean jReguations.-of the Son Joaquin Lac6l kolth,01strict. Home owner or licew <br /> sed <br /> agents signature :f <br /> e th <br /> certifies following: t <br /> . ,6 1/t emp <br /> kplo�yany person In such manner <br /> "I certify that In the perforinance of the work,for'which this permit is issued, I shall r <br /> as to becom jest <br /> o Walkman'sSafnpensation laws of California." <br /> Z�- �_ _- _�-------- ........ Owner <br /> Signed --------1�=------ <br /> V <br /> By __------- ----------------------------------- --------------------------------------------- Title ......... ...................... ......... ............ <br /> (if other than owner) <br /> DEPARTMENT USE ONLY <br /> DATE ------- <br /> APPLICATION ACCEPTED BY ----------------- -------- ------- ................... ... .... <br /> ----•------DATE ---"------ -------------------------...... <br /> BUILDING PERMIT ISSUEDI� -----------------�_ <br /> 7---------- <br /> ADDITIONALCOMMENTS .---------------- - ---I------------------­ ............................................................. ................7 -------------- <br /> ----------------------------- ------•-----...-:.. -------------••-------...----..-..---------.......................... -------- .............. <br /> ----------- <br /> 0 ....... <br /> .............................. <br /> . I...................... ----------------- ----------------------------------------------------------- <br /> ....................................-1------------- ......... <br /> ----------- <br /> --------------------I--------------------------------- ---------- -----------------------------------------*-------------------------------------------------- - ------/ <br /> Fibal Inspection by: ....... e <br /> EH 13 24 1-68 Rev.' SAN JOAQUIN -LOCAL HEA114 DISTRICT '8/74 :'3m- <br />