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MW <br /> Vrrtl APPLICATION FOR SANITATION PERMIT <br />...................................................... ICompfete In TrEpflcate) It No. .. ............ <br /> ..... . ... _ . This Permit Exp res t Year Imam Dae Fouad _ .._.. Date lnue`d.77 <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construd and install the work herein <br /> described. This application Is made In comOlonce with County Ordinance No. 5A9 and existing Rules and Regulatlonso <br /> - <br /> JOB ADDRESS/LOCATION ..� `2 <br /> ..l......�:..u.....�.................... �. }}�� ..............v-PA <br /> :..,.....CENSUS TRACT ........................., <br /> Owner's Nbme ...............................J .........................8 A.............,.....................................Phone ...................................... <br /> Address ... . .. ....... i._....... .. ...... City ---------....-- --•_.... ................_............... <br /> Contrador'sName .. .. '_- ...............................License # A�. ... Phone <br /> Installation willIserves eisfdence Apartment House 0 Commercial❑Troller Court E] <br /> Motel []Other--------------------------------•---------- r <br /> Number.of Ln units:_._-..------ Number of bedrooms _#......Garbo a Grind Lot Size <br /> - � -•-••••---- ...............Private❑.... <br /> P <br /> 1 <br /> • Water Supply: Public System and name -_-- -•-- -- -- - _ -- .6...._.......................................... <br /> Character of soil to a depth of 3 feet:l Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe 0 Fill Material --.___------If yes,type............... ............ <br /> A. <br /> Mot -plan,(ihowi kg size of lot, location of system in relation to welts, buildings, etc. must be placed on revjs1d** <br /> NEW INSTALLATIONs - iNo septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> i <br /> PACKAGI:TREATMicNT [ ] SEPTIC TAMC Size................................................... Liquid Depth ......... <br /> Capacity B� x+Type - _ Material..•................... No. Compartments _ <br /> Distance to nearest: Well: ..Foundation ..10 Pro tine <br /> LEACHING-EINE [ p No. of Lines --------------------- -- Length of each line....... .__.............. Total Length ............................ -- <br /> 'D' Box __f ---- Type Filter Material _:...Depth Filter Material ........................ ..1 <br /> • .0 -�' i Distance to inearest: Wali :s T: St ... Foundation ------------_--•- ..................... <br /> _I Property Line ... <br /> .. <br /> SEEPAGE PIT Depth .................... Diameter- ....... Number .......:........I........... Rock Filled Yes ❑ - No.(3 <br /> Water Table Depth Rock Site <br /> { Distance to nearest: Well ------------------------Foundation .....___............ Prop. Line -.........-..--------- <br /> 1 j <br /> REPAIR/ADDIT ONE rev. Sanitdflon Permit •. Date .:................................I <br /> Septic Tank°[Specify Requirements) i �s� .------..---•-........_ --�� .. .� .................. .........._....._.. ---• <br /> Disposal Fiala lSpecify. Requirements) ._�:�1..tf__Ie� �9 . - .................. === <br /> _ ,.. <br /> .................................................•-• .......................................� .....................I...... ....................................................:...... <br /> (Draw exist <br /> --and required addition-on-reverse side) <br /> n «cr ri.�: _ ._�_ <br /> I hereby certify that 1 have prepared;`t wa 'applk llo�n and,that the work will be dono­ln-accordance with San Joaquin <br /> County Ordinances; State Laws, and Rules and Riguld.loni of the Sari Joaquin Local.-Health I7lstrict. Home owner or liter• <br /> sed agents signature certifies the fallowing: <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 becom I ac to 1 grkman's Compensation laws of California:' <br /> Sinned .... ..... ......................... <br /> ....................... Owner <br /> , <br /> By .............. ........... ........ ....... .. Title <br /> of other than owners <br /> ' . FOR DEPARTMENT USE ONLY <br /> .. DATE -57-' •7:7........ <br /> APPLICATION ACCEP'(ED,8Y ... .... . . ....... ..... .. . . .._.DATE _._ •�,.�-_.: . <br /> BUILDING`.P.ER'MlT ISSUED <br /> ' <br /> ADDITIONAL COMMENTS ------- ' <br /> ...........................•. --.._......-•-- -•---.!._.... ........ �.. ..........---......._._........................................... ._........._..._......---................I........ <br /> . <br /> .......................... ------... ............... <br /> Final Inspection 1� ................. <br /> p y: .----- Date . f..:..��.................. <br /> IIs 13 24 1-68 Rcay. SAN JOAQUIN LOCAL HEALTH DISTRICT 8/74 3M <br /> i <br />