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FOR OFFICE USE. <br /> .............•-•....:...•-•---.........._ <br /> APPLICATION FOR SANITATION PERMIT...... <br /> lCompleto In Triplicate) <br /> ........................•.....:.......................•-• . <br /> Date Issued I;L�-2�� <br /> ........... ......I........................ .......... This Permit Expires I T� *From Date Issued <br /> Application is hereby made to the San Joaquin ocal 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/LOCATION.,:1 -3-OS.Z-.C--..Pl()A).1:100-CJ, ...................... ........ <br /> Owner's Name <br /> .................aNSUS TRACT <br /> 4Z_. _< 44,�;' <br /> ......................... kv <br /> ) <br /> ..... 37�.p......................... ......I....... .......................Phone ............ ...................... <br /> Address ......... <br /> City ... <br /> ............ .......Wll+vlr r­................ ......­..­------ .......... ..ELiil ...... ............................ <br /> Contractor's Name ... yl)..J.................... ............................... ......License * ........ ............... Phone ------------------­--------- <br /> Installation will serve: 'Residence KAportment House] Commercial OTraller Court 0 <br /> tel 0 Other........... ............... <br /> N <br /> ng,uMts Number of bedrooms _.�=__Garb e Grinder ............ Lot Size ........... --------------­----- <br /> Number of livi n At f-t <br /> , k e-4 k <br /> Water SupplV.7ft6lied-Syste.rh and name ....... ....................................f9........-------m.......................... ............... Private 0 <br /> Loll.- In— JFAY I f <br /> Character of soil�to a cle&Kof 3 feet. Sand[J Silto Cloy Peat 0 Sandy Loom r Cloy Loam 0 , <br /> I Hardpan 0 Adobelo Fill 4aterial ............ If yes,type ............... ............ <br /> (Plot plo' sh 'Ing.,slz��of lot, location of system In relation to wells, buildings, etc. must be placed on reverse side.)., <br /> 0 1 ow �r, *4;� A pit"permitted NEVINSTALLATION:' (Na septic,tonk or seepage permitted If public sewer is available within 200 feet,) <br /> PACKAGE ............•..... Liquid Depth �................ <br /> _TREATMENT f ] SEPTIC TANKf Size.... ...................... - ----- <br /> OrMaterial..._..-...----._------ %2 <br /> 7 Capacity ----_-------";Z'�'Type .... No. Compartments ................. <br /> 00 <br /> Distance to nearest. Well 41A---w...........-Foundation .---.:-•----•----..:,Prop. Line ............ <br /> 5_ <br /> LEACWI GILINE H No. of Lines .45"t........ ... Le- th of each line. 7 <br /> ng Total Length .... .........M <br /> V Boxa-�".'='y"'� Type Filter Material ....................Depth filter Material :'r........................... <br /> .......... <br /> -Distance to nearest: Well _5'().:---------- Foundation Property Line '.::k...............a A.? <br /> SEEPAG -PIT D e`pih ....... Diameter ...X.6. Number ...... 'd ..�Yes No <br /> .......... Rock Fille' <br /> Water Table Depth .............. tj - <br /> .......w..................Rock Size .......3 -------- <br /> .................. <br /> Distance to nearest. Well .....6P-_----_---_---------Foundation ---- .... Prop. Line .... <br /> O!EPAII DDITION.(Prev. Sanitationi Permit# ............................................ Date ............................. <br /> Septic Tank (Specify Requirements) ...................................................d........................ ........... <br /> ....................... <br /> n . <br /> Disposal Field (Specify Requirements) ------------_--- .................................................................... <br /> .................................. <br /> -------------- �.............. <br /> --------------- --------------­-------------- ...................................... ........................ ------------------------- ............ <br /> --------------------------------I------------­-------------- ---------­­---------------------—-------------I.............................. <br /> ...............................I................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done-in accordance with 566 Jidquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Local H&olfh,,District. Home owner or'llcon- <br /> sed agents,ii9iiiature certifies the fallowing: 'N- <br /> "I certify thafin. the performance of the work for which this permit is Issued, I shall not employ any person In such manner <br /> as to become sublort to Workman's Compenscition laws of California." <br /> Signed -------------------- .. ... ....... ..................... Owner <br /> sy .... ...I& f <br /> --------------------- -------------------------------------- <br /> .!Lffif-'Oth�r than owner) Title .................. --------------------------------- <br /> An FOR DEPARTMENT USE ONLY <br /> �evf ----- ---------- <br /> APPLICATION ACCEPTED BY'_ - -_ -_ -:-::Z�.Z ......► ........... ....... ......DAT <br /> BUILDING PERMIT ISSUED --------------------------- ------------- -1: <br /> ...... DATE .............. <br /> ADDITIONAL COMMENTS ..-------•------------ ------------ --------- <br /> ZZ4k <br /> ............. ......................... -- -------------------------------------------------------------------- --------------------- ------------------------------------- <br /> ..................... .............. <br /> ------------ ------------ <br /> -------- ----------- ------------4------- <br /> Final Inspection b - ----------- ate __-/_ <br /> 1-66 Rev. <br /> ....... ...... .. .. <br /> ------------------------------I ....... ...... <br /> Y. <br /> EH 13 24 <br /> SAN JOAQUIN LOCAL.-HEAL DISTRICT 8/7h 3M <br />