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M, FOR OFFICE USE: ?, l <br /> APPLICATION FOR SANITATION PERMIT <br /> 1- <br /> . ................................-...............------- Permit No. <br /> (Complete In Triplicate) �s <br />' ....... ...........�-- -ml - TVr- Date Issued ./..�-. .7 <br /> This Permit Expire Year From Oaf*Issued <br /> AJ <br /> Application is herebiJe to the n Joaquin Local Healt bistrict fora ermit to construct and install the work herein <br /> described. This applicationy"sm� e in.co Bance with unty Ordi once No. 549 and existing Rules and Regulations: <br /> q <br /> JOB ADRESS/IOCAV N1... S ,....CENSUS TRACT <br /> .-• .. ......- . <br /> .......off.... <br /> Owner's Name ------- ....'�-- ..-,._. nl ..... .. P <br /> hone . / 77 <br /> f <br /> GG Cl �t-�e- l........................................ <br /> Address ..� .. c. -----le?. Xd- <br /> I <br /> Contractor's Name ...._. .... .. #`T !�.1..............................License ioU .... Phone . b...... ... <br /> Installation will serve: Residence Apartment Housefl Commercial OTrailer Court 0 <br /> � <br /> . / Mote! Q Other_.�,�: <br /> Number of living units:......(_.... Number of bedrooms _-_-•....Garbage Grinder ...--.-:---- Lot Size ...........I-e..........................:... <br /> Water Supply: Public System and name _.--- ----_------------------- ................................................Private <br /> f Character of soil to a depth of 3 feet: Sand 0 Slit❑ Clay Q Peat❑ Sandy Loam [] Clay Loam ; <br /> Hardpan Q Adobe' Fill Material ............ If yes,typo. ............ .......... }' C"A r ) <br /> (Plot plan, showing size iof,lot, location of system in relation to wells,-ings; dtc.�mm jst" e`placed on reverse side:) w <br /> NEW INSTALLATION: (No septic tank or seepage fpit;permitted lif pub!C4ewer;is available within-.208 feet;'--7.�.. ..� .. � <br /> PACKAGE TREATMENT [ l SEPTIC TANK Size....... L� �'''` #. UquidDepth_ <br /> Capacity Type Mae cl..� .Lt' r.. No. Compartments �- <br /> Dil nce ton crest W Ir.- ..__.. ` `Foundttt:o Q=_.. Prop.Line':. . <br /> A. •• <br /> LEACHING LINE YJ o. of Lines - .......... Length of ach fine...-...sS' ... ... Total Length ..... ._. 1.4.4 <br /> V Box ....,tom Type Filter Material _.... ...-.Depth .Filter Material .....-...1�..... ...... <br />} r .�r............. <br /> Distance to nearest: Well .... �.. ..... Foundation ---fQ.-.74�........ Property Line ........................ <br /> SEEPAGE PIT she th ...`Y�... Diameter ...... Rock Filled Yes K No C <br /> .�.,.. P� .�Z. Number ........`? <br /> Ile <br /> Wates Table Depth .:..-•-------------- Rock Size-e MW.__- . v <br /> ' Distance to nearest: Well .._....Foundation . ..._._ Prop. Line <br /> REPAIR/ADDITION{Prev. Sanitation Permit# -------------------------------------- ---- Date .................................. <br /> k <br /> Septic Tank (Specify Requirementsj. ------------------------------------------------------------------------------------.................................. - <br /> Dispo%al Field (Specify cements) ------------------------ ..............................................-.............. ...............-........................... <br /> . <br /> a r , <br /> ---------------- -------------------------------------------------- ....... <br /> ............... ------------------- <br /> -------- <br /> ---- - ---- -- ---------- --- - ......----- <br /> {Draw existing and required addition on reverse side) <br /> ti hereby certify that I hive prepared this application and that the work will be done in accordance with San Joaquin <br /> Coun%Ordinances, Stat;^.Laws, and Rules and Regulations of the San Joaquin Local Health:District. Horne owner or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work For'which this permit is issued, I shall net employ any person in such manner <br /> i as to become subject to Workman's Compensation .laws of California.,* <br /> Signed ..... . <br /> i Owner <br /> By -- i"--- .------ -----•-- - - •---------•-----••--•--•- Title <br /> (If o er hdn owner) <br /> DEPARTM USE ONLY <br /> APPLICATION ACCEPTED BYL/ ----- <br /> BUILDING PERMIT ISSUED <br /> .......... D <br /> ADDITIONAL COMMENTS <br /> --•-----------------•------ ..-- ----- ---- - ------ <br /> --- <br /> ------------ -l`'- T•x...�.....-- -- ... ..- <br /> . . <br /> ------•------•--------- ------------- ------- <br /> Final inspection by: ............. ....... ...............................................-Date <br /> EH 13 24 1-68 Itev• 5m SAN JOAQUIN CAL HEALTH DISTRICT 8/7h 3M <br />