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FOR OFFICE USE: APPLICA'EiON FOR SANITATION PERMIT - 6- <br /> Permit No. ...7 •- <br /> All <br /> ``................................... (complete in Triplicate) <br /> ` ................................ i <br /> CI Date Issued 73 <br /> ..... �( <br /> '-"" ✓� This Permit Expires 1 Year From Date lssve <br /> ............. Y <br /> wor <br /> Ordinance No. 549 and existing Rules and Regulations: <br /> hereby made to the San Joaquin Local Heolt District for a permit to construct and install the Regulations: <br /> herein <br /> Application is Y compliance with County <br /> described. This application is made In co ) .•.,..CENSUS TRACT <br /> ADDRESS/LOCATION...�.�`�I._�.,�.....�.... ..............................:..i .. � .Phone ._ . . .... .. . <br /> JOB ) r� ` ...,_. .-....,..... ............ <br /> Owner`s Name ............. .............. ity i' .i-.ri.d_f= ....................................... ...�. <br /> Address ��.`�--•*�,....... - --}"' l� License9�3..�..._ Phone <br /> yje <br /> V.J.!- <br /> - Contractor's Name .. a--o-•K•-a-�' � Commercial{]Trailer Court (] <br /> Residence(A Apartment House tJ <br /> installation will serve: ; <br /> l .....---•••--- <br /> Motet❑Other ...................... ... • ....... �'�---�,`1,4.. ---...__... <br /> .._Garbage Grinder ...... Lot Size ••--- <br /> Number of living units:....)...... Number of bedrooms ..... Private <br /> n .......-Silt Q...-Cloy <br /> .._._..._ :. -.-�.---r <br /> i Public System and Home _...___. ` Clay <br /> I Water Supply: Peat`Q Sandy'Loam t] Loam <br /> depth of 3 feet: Sa D i <br /> Character of soil to a '{' <br /> Hardpan� Adobe If yes,ty r <br /> F etc_r[,us4 be placed on reverse side-) `C <br /> {Plot plan, showing size of lot, location off sy-stem ;n_relationtto wells,Jauildings,_ <br /> = it ermined if public sewer is avaiiab�e withinf 200 feet,) <br /> II-- <br /> NEW INSTALLATION:, {No septic tank or seepage p p i /D Li uitl Depth • .............'••---•. <br /> Size.............. --..e , <br /> PACKAGE TREATMEiST- [ ] SEPTIC TANKS s <br /> Material.�n-�rY- e- mpa Li <br /> o.i <br /> Ccpacity C1Qciak type�••-... y �.- .— 1 '. Cm e <br /> fJ ent <br /> •-- P p• n 1o�rfC <br /> � �- Foundation _.-.LD-�-�� <br /> i �-ti-----� -rw•� Distance to nearest: Well .-.._/..O..A_.-••_••-_•••-•••_ _• .•__-._••.._. <br /> ch[ No. of-lines ........ ............ Length Length of ea <br /> line.....!.. !J ....... ota1;•.len�th ..-.11�� r <br /> I LEACHING LINE � -/�_............................. <br /> - ' ' e th Filter Mgteriulr ��..-.. - <br /> .. '`v '! f <br /> ` Fitter Material -•...... .. ........D P...... .. <br /> 'D' Box ... �.- Type <br /> i �- Foundation lam.......... rope�Tty Line ...fd <br /> Distance to near 't:.Well .......5_a•• •••-• Rock Filled Yes.$] No Q <br /> Diameter . .. Number ----...----•• <br /> l r . <br /> SEEPAGE PIT 4( Depth 4 _. <br /> Water Table Depth Q=-�•-••`••••--••••--. Rock Size r <br /> i <br /> �. nearest: well ./.... �•.................Foundation ---•-- tin <br /> P op. -- - <br /> Distance to <br /> t <br /> I l.. �.:. Dame ..................................I L <br /> _......-- `� <br /> REPAIR/ADDITION(Prev. Sanitation Permit .............................. <br /> 'SeptiG••Tank (Specify Requirements] ...-.•- <br /> .lGQ. . <br /> i f�.O_. .... <br /> or <br /> Disposal Field (Specify Requirements) .......... •- <br /> , ...... <br /> r <br /> l ` I <br /> ............................... .......... ...___..... <br /> ' . .........."............__......_-. ._...__._........._.._.._......._.._.....--..-_ .r•--�.-..-:..- <br /> - .......................................... ......... ......... <br /> :(Draw existing and required addition on reverse side) <br /> I application and that the-.work will be done in accordant with San Joaquin <br /> I I biereby certify that I have prepared this app <br /> County Ordinances; State Laws, and Rules and Regulations of the SanJoaquin Leta! Health District.Home ewwer or last- <br /> ' sed agents signaturh certifies the following- le any person in such manner <br /> "1 certify that in the performance of,the work for which this permit is issued, 1 sfiall not employ <br /> as to become subject to Workman is Compensation laws of California." <br /> i .......... Owner / <br /> Signed •------•----. •--•--.... <br /> ...................."......... , <br /> •. <br /> . Title <br /> l (If other than owner) ' <br /> j FOR DEPARTMENT USE ONLY <br /> l ' <br /> DATE )�r,.........:....... <br /> APPLICATION ACCEPTED BY <br /> DATE ................... <br /> BUILDING PERMIT 'ISSUED .... ..:...........t- Z.::..........:........:...........:..........:.................................. ......----...__..........._..... <br /> ,, <br /> 4 ADDITIONAL COMMENTS ..::......_ ........................................_......_..................•-- <br /> I ................. ....... ._.........._:_..I..............-.....__.... .._.......... _"...:._.... <br /> ........................... .. .... .... ......._.. Date .. .. � f�� ••--- <br /> Final Inspection <br /> I } SAN JOAQUIN 'LOC_Al H DISTRICT <br />