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_ 1 <br /> ' f <br /> FOR OFFICE USE: APPLICATION FOR,SANITATION PERMIT i L/ <br /> Permit No. .7"7.`.5 <br /> .................................................... (Complete in Triplicate) <br /> . ........I................. Date Issued . .- <br /> F This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local <br /> e cwi h Cc�ytQrdinfor <br /> nce permit <br /> and existing Rulesinstall <br /> nd Regulations, <br /> described. This application is in cam y�om <br /> 111U�l6C R ��` <br /> ,. �� �"" '�" ' ..........................CE ............:_.......... <br /> I.l�RO(�G- CENSUS TRACT ' <br /> JOB ADDRESS/LOCATION . •. .... -•-• ... <br /> Phone7 ..... ..... <br /> e <br /> Owner's Name ..... ...... ................................. <br /> > <br /> .. .............. <br /> n ......... <br /> Address .......o'�.�-/��---�•x ............. ........• <br /> ' _,& .���' � License # /7785 • . Phone <br /> Contractor's Name -..�lif� - k , '`�>`�" - <br /> Installation will serye: ` Re6dence:g Apartment House 0Commercial -]Trailer Court ❑ # <br /> Motel ❑Other ............. •--------------- <br /> i <br /> t Size <br /> l � r�•••...............• , <br /> Number of living units 6.....L...... Numb& of bedrooms _--. .._Garbage Grinder -/VlT--- Lo .. --- <br /> - Private 1 ' <br /> Water Supply: Pu it S m and name ---------------------------------------_ .................... --.._.. - ... <br /> Peat Sand Loam-� Clay Loam ❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt� Clay-n Peat y <br /> ;Hardpan ❑ Adobe& Fill Material :.------...- If yes,type <br /> (Plot plan, showing size of lot, location bf 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 /> X Depth _. ' <br /> Size. <br /> • �-r" ' ,;Liquid :... <br /> PACKAGE TREATMENT [ } SEPTIC TANKS <br /> ' Material <br /> / --- -_• <br /> - ts <br /> - Nd� C <br /> e MaterialTYpCaPacitY ��GProp. Lin <br /> e --...Foundation ... <br /> Distance to nearest Well ...__- •" <br /> s. , <br /> . Total Length �Q.....__. <br /> No. of Lines <br /> --•--.�..__-- --••--- length of each line.------•-- •-•- -- ' <br /> LEACHING LINE - � re ' <br /> 'D' Box .�Sl--.... Type c' Filter Material ../?, . --.-•-••-- -.-•--.-`.._...�' <br /> Distance to nearest: Wellef.M^--^-"- F datiat <br /> on t-`:.- r .... Property line .--5....._ .'' � <br /> I ' .� umber ._.. .,�....... ........... Rock Filled Yes'R) <br /> SEEPAGE PIT (yam Depth .... .. -.._._ Diameter c -- --.. <br /> ., <br /> r. <br /> ` "ck Sixe 1� <br /> Water Table Depth UpD--••-------•----••--• =..Ro � <br /> FoundationI --...:. Prop. tine ......._-• <br /> "••"-" <br /> Distance to,nearest: Well "' "' <br /> Date <br /> REPAIR/ADDITION(Prey. Sanitation Permit# ••••--- ----- ` <br /> Septic Tank (Specify Requirements) _.--••-------••-•••-•--•----•-••................ ' <br /> Disposal Field (Specify Requirements) ­---­---- --------------------------- t <br /> ---------- •••. <br /> ------------------------ <br /> ---------------------------------- <br /> ------------------------------------------- <br /> --••---..-- <br /> ---.....--'---...--- - ............ <br /> -------------- ------•--."-•---•� .. <br /> ------•---. ------ •- <br /> - ---•---. I....--....--....J...........-_..---........F._.......-•----....-...---...--...--...--..-...-...... <br /> � ; (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will bedone in accordance wish San Joaquin <br /> L. County Ordinances, State Laws, and Rules and Regulations of the San Joaquin:Local Health District. Hayne owner or licen- <br /> sed agents signature certifies the following: "� r+ <br /> "I certify that in the performance of the work for which this permit is issued, I shat{ not employ any parson {n such manner <br /> as to become subject to Workman's Compensation laws of California.'.' . <br /> Signed ---•----- Owner <br /> . Title ...- � . ............. <br /> A — <br /> (if other than <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .--. ------ --_-• -- •• •• ---•...... =--------------- -- <br /> DATE �� ... . <br /> BUILDING PERMIT ISSUED ...-- ,... .._ -.. :.. <br /> ...... <br /> DAT <br /> ADDITIONAL COMMENTS ----- <br /> s: ':a.. .....:7� 7 <br /> ..................................;.1................... ._ .: ...... yam.. ....... ......-' -`.. <br /> .....-. -- Date _...-�-•- <br /> Final Inspection by:..... - ..-- _• •-- -----• -••...... -_............... <br /> SAN JOA IN LOCAL HEALTH DISTRICT' <br /> 7/723 M. <br />