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FOR OFFICt USE:`� APPLICATION FOR SANITATION PERMIT <br /> Permit No: __`y_Z�_-�_r_� <br /> - --------- (Complete in Triplicate) <br /> Z zr -7Y <br /> --------------- <br /> ----------------- <br /> ------------------------'- -'--- Date Issued ----'=----- <br /> I t <br /> This Permit Expire's 1 Year From Date issue <br /> - <br /> it to construct and <br /> all the work <br /> or a <br /> rm <br />` Application is hereby made to the Son Joaquin Local he Co ty Ordinance nan a No. 549 and existing Rules tand Regulations <br /> [e,n <br />► described. This application is made in compliance with CENSUS TRACT <br /> � a_ - ------� <br /> JOB ADDRESS/LOCATION . _ -' ` - -----------------------Phone <br /> / ,�'�N_" "!_ . ✓ ' ------ <br /> --------------------- <br /> Owner's Name "--- <br /> 1, , ------------- City -------- --------�-- ----- ---- �-�� -- /,?/ J <br /> Address ------------------------------ --- -. -- <br /> -------------- - <br /> �� ,%~.--- -- Phone ---------------•----- <br /> __ License # ------ ':- - <br /> ,( S��C------------------------- <br /> Contractor's Name __�'-�4ir�T�---���'--""�-- - <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial:.[]Trailer Court G <br /> i i Motel [I other ---S"c.��- -----1-`D!l_-F <br /> Garbage Grinder ------------ Lot Size ------------------ --------- <br /> Number of living u -------- Number of be <br /> -___-____-- -----Private ❑ <br /> ------------------------------------------------------ <br /> k Water Supply: Public System and name ------------= - Peat❑ Sandy Loam Clay Loam ❑ <br /> f T feet: Sand'El <br /> .Silt❑ Clay ❑ <br /> - Fill Material ---------�," If.yes.-type ---------------------------- <br /> -Adobe --� <br /> Character of soil to a depth o <br /> Hardpan ❑ <br /> size of lot, location of system in relation to wells, buildings, etc. must be placed OO eet} <br /> NEW INSTALLATION: (No septic tank or seepage pit peon reverse side.) � <br /> (Plot plan, showing rmitted if public sewer is available within O <br /> PACKAGE TREATMENT [ SEPTIC TANK T <br /> Size �'1 � ------------------ Liquid Depth ----X11------------------ <br /> Capacity aV _-TypepY 4'A_rMaterial_-_ A`--- No. Compartments ___--- <br /> c <br /> P Yt j �� , f CJ---------- Pro Line ------- <br /> A �-------------------Foundation ----- --- -- p. � <br /> tante to nearest: Well - - r <br /> r ;, �Q Total Length ---IM <br /> # No. of Lines --------/-- - -------3 Length+of.,each line------ - - ------------ - <br /> LEACHING LINE [ I / yDe - De th Filter Material --------; o..--•-- -------------•------- <br /> ! `D' Box ----/----- TYPe Filter Mater}al __- - P p <br /> �,� ------------- Property Line <br /> I _"__"_ Foundation _-------- <br /> 41 <br /> Distance to nearest: Well No ❑� <br /> ) l '' Rock Filled Yes ❑ <br /> Depth ------------- Number ---------------- <br /> SEEPAGE <br /> - ------ --- <br /> _ Diameter � <br /> SEEPAGE PIT [ ] 1 <br /> t. <br /> .�.-.�,� ------ Size -=-t'-; ----:;--- ------- <br /> --Rock <br /> Water"Table Depth _------------- -------[--------I <br /> Foundation --------------- Prop Line - <br /> Distance <br /> 1 <br /> to nearest: Well ------t"--" ------ r <br /> ! r Date ---------------------- <br /> REPAIR/ADDITION(Prev. Sanitdi ) <br /> F ------------------------------------------------,< <br /> IN , <br /> -------- - <br /> Septic Tank (Specify Requirements) _-__------- ' ---------------- <br /> ' y q y ` <br /> (Specify Requirements) ----•-------------------------------------- <br /> Disposal Field (Sp Y q' I -----------•------------------------- <br /> ------ -- ------------- <br /> -----------------}j <br /> F i ---- <br /> ""._ <br /> "---------"-------------------i-------------------------- <br /> ----------- <br /> -`---------------_------"-__-_. <br /> - ------- ----------------------------��- k � [Draw existing and'required.dddition on reverse side)hat the work will be = _ -�" •• " '�'" <br /> ne i <br /> I hereby certify that I have prepared this application and tollealth District. with <br /> tHomeowner or I cen- <br /> ! County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local <br /> sed agents signature certifies the following: person in such manner <br /> "I certify that in the performance_of the work for which this permit is issued, I shall not employ any <br /> F as to become subiect to Workman's Compensation laws of California." 1} ' <br /> I ' Owner <br /> t Signed -. !� <br /> _y,- O r --------------------------------� o <br /> - ---------- <br /> -r} =_..----- ---------------- <br /> By <br /> -------------------- Title .--------- ' <br /> (If other t <br /> r i FOR DEPARTMENT USE ONLY If <br /> ' TION ACCEPTED BYE-- _�®` ' ----------------- •---- DATE -- -` <br /> APPLICA ----- ------ DATE _." ' <br /> ' ---------- <br /> . BUILDING PERMIT ISSUED ----------------------------- ---------------- - <br /> ADDITIONAL COMMENTS ----------- ------ ----------------- -------- <br /> --------------------------- --'- - -------------- <br /> -' 5"__-___ __-__ ------------------------------------_-------------_---------------------"-_-"--"-_-_- <br /> -_---- ----------------- '--- -- -__ ------------------------------------------------------- <br /> ------------------ .-__ <br /> -- -- � --- --- ate -------------- <br /> ------------------------------ --- - - <br /> Final Inspection . - = -.-- <br /> A� <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> c u 0 1-'68 Rev. 5M <br />