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FUR OFFICL-4- APPLICATION FOR SANITATION PERMIT � <br /> ........... .............................. !complete in Triplicate) = / <br /> Permit No. " <br /> Date Issued .................... <br /> This Permit Expires] Year From Date Issued <br /> and <br /> l the <br /> Application is her made to the San Joaquin wiHh County ealth District <br /> d narnce permit <br /> and existing Rulestalnd Regulpt onsrein <br /> described. This application is made in compliance <br /> ........................... <br /> [_ .. 14,fAl ?' " ............... <br /> JOB ADDRESS/LOCATION f-.. E one x3 <br /> CENSUS <br /> ......Ph <br /> Owner's Name ,_._... ...-....._. <br /> -------------- t <br /> AddressC . T.'.......... ... City . ... ....�.._.._. <br /> .................... <br /> ... .................. <br /> Phone �. . <br /> Ce�. �--..�'--� --•- '-•�-�---.License �•� <br /> Contractor's Name ............. . ....•� ---- <br /> Installation will serve: ' ' Residence JAApartment House{] Commercial OTrailer Court 0 <br /> t`` Motel [3 Other .. <br /> ••---....... Lot Size � r�,l Z.................. <br /> Number of living units:... Number of bedrooms _.. <br /> .---..•Garbage Grinder 1........ <br /> . .............................................Private <br /> Water Supply: Public System and-name __...--_--- ............. <br /> _ * Peat❑ Sandy Loam p. Clay Loam 0 <br /> Character of soil to a depth of 3 feet: Sand E] ` Silt Q Ciay <br /> �._ <br /> Hardpan ] Adobe' F11.1Material __.... ..1f yes,type ....•..•....... ............ <br /> (Plot pian, showing size;4o#llot, location of system in relation to wells, buildings, etc. must be placed on reverse slde.l <br /> NEW INSTALLATION: (No septic tank,or seepage pit permitted if public sewer is available within 200 fee ,) <br /> • � -.� - . Liquid Depth ...��..............S <br /> PACKAGE TREATMENT I I SEPTIC TANK P4 Size------- -.X_1 ..__... <br /> pp No. Compartments ... ... .... <br /> Capacity �60D Q- Type ....................� Material p . <br /> pa tl`L-•---------- <br /> ? --_Foundation 1_.4. ..:._._Prop. Line ...A............... <br /> Distance to nearest: Well �.Q'.- i <br /> Q-_.......•--..._.. <br /> . . i Len th-of each line.. 5. .....•""... Total Length ....1. <br /> LEACHING LINE . No. .af.Lines 9if 3 <br /> } 'D' Sox __(Ve5_ Type Filter Material Depth Filter Material ...A?......................... <br /> 0 t !�_... '.,_... Pro a Line ....�.............. <br /> .j .. Distance to nearest: Well .., -.........4.... Foundation ..- . p rtY <br /> /A. Diameter &.K .•-� Number4..._...�.. ............. RockFilledYes No C1 d <br /> SEEPAGE PIT 04 Depth _ I <br /> _--Rock Size .. I..f ....... <br /> I/ Water Table Depth - --.'..._ •-- <br /> Distance to nearest: Well Foundation -.__�Q--?-..... Prop Lino ..__......• .__..._.. <br /> _. . .. I T 7s" .._......-- <br /> REPAIR/ADDITION(Prey. Sanitation Permit.# •-----•-•-- - ate ____•--------------- <br /> i <br /> Septic Tank {Specify Requirements) ...:._ -.......... ..,............. <br /> Disposal Field (Specify Requirements) __...... <br /> -._-----•-----------••-•..............•- <br /> c 4 <br /> Y <br /> ........................................... <br /> ______________________ ................................... <br /> __ ________ ___---. <br /> .............. <br /> ............................ <br /> --------- -------------•-----•----!---•-. -----.......__...._..__...._._........:•----•........_._�:..... <br /> (Draw existing and required addition on reverse side) , <br /> cco Inc* with Son <br /> quin <br /> ! hereby certify that:! havepreparedlesaandi Regulon and ations ulationsthat the Work will he of the San Joaquin LocaloHealth,District. Home owner or licew <br /> County Ordinances, Slate Laws,ws, annRules <br /> sed agents signature certifies the following: person In such manner <br /> "l certify that in the performance of the work for which this tieimif is;issued, 1 steal not employ any <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------------- Owner <br /> ----••- <br /> - Title ----- <br /> --- --------- --------•----------•- - <br /> ------------•--.--- <br /> (If of r than owner) <br /> R P TMEN US OLY <br /> ._S=.S`-�-�� <br /> APPLICATION ACCEPTED <br /> - ----- - - --------- - /// <br /> �-•� ---•--------•-- <br /> -DAT-•-. DATE ............------------------------------- <br /> BUILDINGPERMIT ISSUED ---------------------------------------------------------"-------•---- ------••- <br /> ADDITIONAL COMMENTS --------------- ...-• --....----• --•----- -••--------....----.........._.... ... <br /> ----------------------------------------. ..-"---------------- ............... ..--•------ ------------•-----•---- - -•---..-.-..� .......-. <br /> ----------- ------------ -----••------------------•-------------------- •-. ........-- /-' <br /> J �.�.�F_ �.... <br /> - - -------- Dote _../' -.... <br /> Final Inspection b • - • <br /> lH 13 24 1-68 Rev. 5M SAN JOAQUI LOCAL HEALTH DISTRICT 8/7�i 3� <br />