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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> :................. .. Permit No. <br /> (Complete in Triplicate) <br />..•..:................ <br /> 11-T <br /> � Date Issued .. :-.Z <br />-------............................ ...............:..... This Permit Expires it Your From Date Issued <br /> 51 <br /> Application is hereby"made to the San Joaquin Local 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 .....rg/`.9'7.,5 ....�?�.- <br /> �j VI 'C1. F1.1 <br /> t , u...........................�.....CENSUS TRACT ........ <br /> Owner's Name ... ... <br /> ......................................:.........Phone .................................... <br /> Address ' ► .. 9r..1.:1..........S....:.. > _. ........ .... . ........ City ....4 s, -< . ... _ <br /> ..._ <br /> Contractaf'`s Nametea (C ERA11 r�......License:# ......................... Phone <br /> Installation will serve: Residence []liGar'4667nt H6se❑ Commercial ❑Trailer Court 0 <br /> Motel []Other`; ....... <br /> Number of living units:.... ....... Number of bedrooms- ......Garbage Grinder fig5. Lot.Size BcRSA . .....:........ <br /> Water Supply: Public System and name ...... .............. ......••-•-•-•-------•-...........--............ -•--------•---••-• -••--..._......---•-Private ©� <br /> Charocter�of soil to a depth of 3 feet: Sand'❑ Silt 0 Clay ❑ Peat 0 Sandy Loam Clay Loam ❑ <br /> �f Mat�I' �. � -- <br /> Hardpan ❑ i Adlq <br /> obe it eria : ... If yes,type <br /> (Plot plan, showing size of lot, location.of. system in relation to, wells, buildings,etc,„rnust-f;1e�piaced on reverse side.1 <br /> NEW INSTALLATION: (No septic tank or.seeps it permltted_if,publ,ic.,sewer is available within 200 feet,) �/, <br /> PACKAGE]TREATMENT [ ] SEPTIC TANK [ Size. ... `. ................. ... Liquid Depth _... �..._....... <br /> Capac ty . 0.1 .... Type 6Cj4 Ma terial.��P!!IC;-...� P Na. Compartments .. Z—..... <br /> ._ <br /> is �j� r <br /> Distance to nearer#: Well.`:::.: �.?'-' :`LAS' ......Foundation ............... .. . Prap. Line . <br /> /D ='— ov <br /> LEACHING LINE [11r No. of Lines <br /> { ; <br /> .. ,::.':, lergthofeach line. <br /> ....... <br /> ...... Total Length ---•--_........... kn <br /> 'D' Bak Type-Filter-Material ��1��,._::Depth;Filter Material ...::..�� r <br /> r <br /> !1 .--.•.._..... <br /> ' Distanc�ta,.nealest: Well ...,?�..^�.:..'�: �Foundation � ___ � Property Line .� "'L Vs � <br /> SEEPAGE-PIT [ ) Depth ................... :Diameter ......:.. Number ..........................:. Rock Filled Yes ❑ No ❑ . <br /> Wate"r Table Depth ------- - -------- Rock'Size ..... <br /> ..... <br /> Distance to nearest: Welit Fours otion ..... Prop Line ...................... ; <br /> REPAIR/ADDITION(Prev. Sanitation Permit# �- I <br /> ------ bate ................. <br /> Septic'Tank (Specify Requirementsl -•-•---- ................. :.. .....-........ <br /> , _ __...... . . .... .. .........................................•--•.._.-----....---••-• p <br /> Disposal Field (Specify Requirements) ---•-•............... :,.................---------....................._....I.... <br /> . I _ , <br /> .............................3 ............................................................................... ............ ... . <br /> .......................- - "-- 1.. .�—....... - 1C•-- ewr.i mos-s.a._.. <br /> } <br /> .._. .�. .......... -.. <br /> ' !'(Draw,eiiisting and regviredladdition on reverse side) <br /> I hereby certify that I have prepared this application and that the walk.will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local HealthDistrict. Home owner or licew <br /> sed agents signature certifies the-following: : <br /> "I certif t pe or ;of a work-for,w ch this-permit is Issued, l shall not employ any person In such manner 1 <br /> as be me subiect to 'i' o pensatI ws of California." ' <br /> Signe . .... .. . .. Owner" <br /> BY ..... ............... ............... .................:...........: ..... . .. i _ . <br /> 4' I <br /> (If other than owner) !': `i <br /> FOR DEPARTMEWT USE ONLY <br /> APPLICATION ACCEPTED BY . �---•...................... ....••---. ...... ......... --..... DATE ... :. .`.7. ....t <br /> *BUILDINGPERMIT ISSUED ............:.. ...............................•--- ................................... .........DATE ------...............-•--• -•------------- <br /> ADDITIONAL COMMENTS <br /> ....._.._....w.... - ....... ........................... Y .t.� !� f 1 ..\� -' .. ~\ i• T.�. <br /> Final Inspection b : ... l ,�..:.— :..:r _ :..::......:.:. , <br /> Y Date .....?..e:f�7`. .............. <br /> 4" SAN JOAQUIN LOCAL" HEALTH DISTRICT <br /> E. H.13 24 1.'68 Rev. 5M 7/79 3,M <br />