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FOR OFFICE USE: .:;5i <br /> .......................... ............... APPLICATION FOR SANITATION PERMIT <br /> Permit No. ,�7 .7,17 <br /> ......... ......................................... .. lCompliete In TApI11caft) ....... <br /> ..................... ................................... This P <br /> tnlmlt Expires I Your From Date Issued <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and Install the <br /> described. This appli * work herein <br /> �tioQ=b-MadcriR-Wmplicmc-o�-with County Ordinance No. 549 and existing Rules andRegu lations. <br /> JOB ADDRESS/LOCATI& 5-71- !Z 0'a <br /> ------- ------ one CT ............... <br /> Owner's Name - ----- <br /> .......................... . <br /> Address /9 -,,-e_ V_ .... n I/-------- <br /> ... ............. .............city /Wfi <br /> /.V, <br /> ............... -------------------------------- <br /> Contractor's Name ...... <br /> --------------------- :........License <br /> Installation will serve: Residence 0 Apartment House f] Commercial oTraller Court 0 <br /> Motel 0 Other... <br /> Number of living units:.......... Number of bedroom* ............Garbage Grinder ..............Lot Size ................ <br /> Water Supply: Public System and name ........... :...Private....................................... .................................................. <br /> Character of soil to adepth of 3 feet: Sand E3 Silt C3 Clay C7 Peat Sandy Loamo Clay Edam o <br /> Hardpan C1 Adobe Fill Moterial ...-,..... If yes,type............... ..:......... <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION. (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANKS ] <br /> size sq�.X;2: Liquid Depth .!�V-----------------ob <br /> . .. - ----- <br /> Capacity Type _p_t.a.........4, Compartments ......2, <br /> ---------- <br /> Distance to nearest: Well ----- ..........Foundation ..../.o--_--.....__.. Prop. Line _...6--------------. <br /> LEACHING LINE No. of Lines _../-------I......­_ Length of each .............. Total .Length .............. <br /> V Box ............. Type Filter"Material Depth Filter Material .1Z.1.......... ................... <br /> � (3 / / *-V <br /> Distance to nearest: Well ......)...o .......... Foundation ..../...4.) <br /> .4�z Property Line ........................ <br /> SEEPAGE PIT Depth -------------------- Diameter ---------- Nuinlber ................ ............ Rock Filled Yes 0 NO C <br /> Water Table Depth .............. ...hock Size ................................ <br /> Distance to nearest. Well ........................................Foundation ............"" Prop. Line .....................iE <br /> OEPAIN/ADDITION(Prev. Sanitation Permit# .....-.............. ------- --_--------- Date .................................. <br /> Septic Tank (Specify Reqvirementsi ......... ........ ........... .......... <br /> ...................... ....... ............. ....... ............................... <br /> Disposal Field (Specify Requirements) ................ .....................I......... ............ <br /> ------------------------------- -------------I................................ ........................ ............. ........... .............. .......... ........................ <br /> ------------­­---­-----------------------•-•-- ••-•----------------------------•------- ....................... <br /> (Drowex' isting and required adds#ion on reverse sidel ------------ <br /> I hereby certify that I have prepared this application and that the work will be do ' in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local in'ectI&DIsIrld. Home owner or licen- <br /> zed agents signature certifies the following: <br /> "I certify that its the performance of the work for which this permit is issued, I shall not employ any person in such manner t. <br /> as to become subject to Way Inan's Compensation laws of California," <br /> Signed ------ --- ---- --------- ............... Owner <br /> By --------- ---- ­77than, , ----- <br /> ---------- <br /> ------ title ....... .................. ...........................(If other aOner <br /> FOR DEPARTMENT, USE ONLY <br /> APPLICATION ACCEPTED BY <br /> ,g...U................------ -------.- <br /> ----------­----- •--•-------------- •-- <br /> --------7--------- ..-.-.I--.-.-.-.-.-.-.-.-.-.....................I...DATE .........................................ILDING PERMIT ISSUED ------- -------------------*-------------------------------------*................... ......DATE .................... .............ADDITIONAL COMMENTS—_ ------------- - <br /> -­--- - = __ <br /> . .. ------- <br /> tI <br /> J( I <br /> --­---------------- ------- <br /> ----_----------- -------- ........................... ....... <br /> ---------------- --- --• -------------- ---- ---- - ----- ...................... .......... <br /> ............................ <br /> - <br /> ---------------- <br /> -j <br /> C ------ -------- <br /> Final Inspection by: ... . .. .......:.............•---.... ... .-...._. . Date <br /> ----I .__"__ ... ......... <br /> EH 13 24 1-6 6 Re 5M SANZJOAQUIN LOCAL EA(TH DISTRICT 8/74 3M <br />