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`.�.•�--� FOR-®FFICi"e USE, <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> ...........................................I............. <br /> tCompiets let Triplicate? G <br /> k..........................I............................ Date Issued ,/�? = :�•7 <br /> This Penult Expires] Year From flap Issued <br /> Application is hereby made to the San Joaquin Local Health Distrl& for a permit. to construd and Install the work herein <br /> described. This application is madeqq Inf complia. a with Cou ty Ordinance No. 549 and existing Rules and Regulation. s <br /> 108 ADDRESS/LOGIT O ,�c ..l ..... . ......r ..... ........ ..........................CENSUS TRACT' .......................... <br />' Owner's Name .. �Qrre'.. 1 .L C!i................................ ...._....... Phone .................................... <br /> Address ....._ ...----G .� ...............................City mss- ................................... <br /> Contractor's Nama � i- ...�++�--- - �1-.. r=�-Licensee �. . Phone <br /> Installation will serve: Residence Apartment House[] Commercial{]Trailer Court 0 <br /> Motel ❑Other............................................ ( <br /> s Garbo a Grinder ::'�:.. Lot Size .. <br /> Number of living units:...,.... Number of bedrooms ..... ;._... <br /> I ��-_`� .Prlvi to ❑ <br /> Water Supply: Public System and Hanna ----. __- i: ....................................---.. <br /> "- o Peat Sandy Loam ❑ day Loam ❑ <br /> Character of soil to a depth of 3 feet: Sa"`dn [ Siit 13 D D <br /> Hardpan❑ Adobe Pill Material ............if yes,type............... ............ s <br /> (Piot plan, showing`size' of lot, location of system in relation to wells,;bu[ldings, etc• must be placed on reverse side.). <br /> NEW II(STALLATION: (No septic_ tank or page pit permitted if gubllc sewer is available.within 200 f4 <br /> --• ,1 ': Uqu Depth <br /> PACKAGE TREATMENT SEPTIC TANK Size.. x id ............... <br /> € Capacity/ •f3. .,13y� �aterlal ..k. ' p� ......... <br /> Noy Cam artmenti;' ` <br /> y�• <br /> a , Distance to nearest:,Well' ....Foundation ......&.......... P p. Line .. ....Ar— <br /> it Total Length i --.�.•.•.. <br /> LEACHING LINE � No. of hues ......sem_--�....... Length of each line....---�............... <br /> � l� i <br /> 'D' Box i.,�. ..:De`th Filter"Mateirial .....- -:..:... ........ <br /> . <br /> Ni .�. - --. Type�Filter Material .��:>;i�-: p '�` <br /> bistance to nears i Well . .Aid& Foundation ,Ae.�......... Property Lute .x�. .�-.. ... <br /> ' SL�EPA�E PIT r�^Depth __&•�......r Diameter .s �_�. Number _..r.. :.............. Rock Filled Yes No <br /> �7 4 RC1 <br /> Water Table Depth !.T-...................................-.Rock Size ..�.. � f <br /> ` <br /> Distance;* nearest: Well .. } :.Cf i g `-- .Fovndatlon..:(.lf...... fbp. Line ..... <br /> r +REPAIR/ADDITION(Prev. Sanitation"Permit sP ............... .......... j....... Date ........................•-- <br /> Septic Tank (Specify Requirements) .. ....... ........ ,.. .............. ....................... ...._............` _._. .......... <br /> } d; Disposal Field (Specify Requirementsy:w- .. . .. ..:.............................:.......... ... •�•s .......,, <br /> y .......................................... s _____.. �.... ................... .............................................. ..•..............-.......�....• ......... <br /> . ...... ........................__._.......,•r'4. .._......... ���.• .: ... I•.......-•-.• _..�.•y Y�' - . .... .._ , •• ' ................. <br /> ' .......... .......................................-.,..:.�..................._. ........ :. ..w. ... .. �.. :.. .. <br /> :.• ..i ................. ._ ..... <br /> �""Pi-awex"i riiand required adc ton-on.raverse_sldel�_ <br /> herelsy_cerNfy that i�lsaye�kreppred this=appl[cation and_that,the work will be done In accordance with Saes Joaquin <br /> County Ordinances, State Lows, and Rules and Regulations of the Sanloagnin Local Healtl+`Dist�lct:Norrie ovkitter or Ilceeo- <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 not employ any person In tuchinanner <br /> as to become subject to Workman's Compensation laws of California." i <br /> Signed ..... -•------••k•-•---•• • ........... <br /> .............................. Owner / <br /> . <br /> By ...... �' ✓ . ...................... Yitle <br /> (lf other than owner) <br /> �_ R EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED $Y . DATE <br /> ............... <br /> BUILDING PERMIT ISSUED ...................•----.......__..:..r..................--- --.......DATE ................ <br /> ADDITIONAL COMMENTS ` <br /> r <br /> .......................... . - •.... ........................... ...4..................._....._................ --- .._....... ....._........._... <br /> . - <br /> ........I............ .............. ......._.__.-.... <br /> Final Inspection by: ...---•............................................Date .. ....._... ...... <br /> EH 13 24 1-68 AN 1 AQUIN LOCAL HEALTH DISTRICT � 8/7!i 31`1 <br /> 4 <br />