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/✓/f 0������� Kf- fih� /2h � sic �c� <br /> FOR OFFICE USI.: APPLICATION FOR SANITATION PERMIT <br /> :. ... .- - -•--....-----•............................ . Permit No. � - <br /> 0 P11- (Complete in Triplicate) <br /> IV • Date Issued .., :.. �j...73 <br /> _--•-••---•;•„ This Permit Expires 1 Year from Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> 1 ` mL it iQ . <br /> r' <br /> _ ._................CENSUS TRACTJOB ADDRESS/LOCATION ...•..... ---_------- <br /> z- <br /> --- ------. <br /> wnN _O <br /> . { .. i .. .-....Phone .4.6. .: <br /> Address ........ .. ...... -. ---- -- . . C TL'[11:.... ' ..r <br /> t <br /> ^ # -Phoned .�7"6l <br /> Installation w'rli serve: Residence Apartment Mouse. Commercial []Trailer Cavrt <br /> 1 r <br /> F .. Motel [Other of.� - . <br /> units:----- Nvmb <br /> Number of living , �__.._. er ,af bedrooms :.c�----Garbage.'Grinder-------------;Lot 5ize <br /> Water Sup,ply: Public System and name.: : ..:...-..; = - :::---_.:.._ <br /> - ....... <br /> { Private {� t <br /> Character of soil to a depth of 3 feet: ` Sand [ Silt❑ :Clay E] Peat Sandy Loam ❑ Clay Loam } . <br /> Hardpan 'Adobe'(] Fill Material If yes,type _�: .- <br /> 3 [ <br /> showin size. of lot,..location of. s`stern.in relation e <br /> (Plot,plan,. g y to wells, buildings, etc., must be .places] ..on.reverseiside.) <br /> ! <br /> NEW INSTALLATION: (Na septic tank or;seepage pit permitted.`If:public sewer is available within 200 feet,) ­qq ­11. y Q <br /> [ PACKAGE TREATMENT [ ] SEPTIC TAN1G [ ] �5iae...a...' ... .�. -P�.-� - f Liquid Depth.. <br /> ' <br /> Capacity : �i rte..._._ Type .. :Y-�:��='t` Materiol.. � ?c aVo: Campartments. ...a ..;_._.... .: <br /> i Distance to nearest: Well: Lcsc� .Foundation .. f ........... Prop. Line . .............. <br /> 06 Total Length <br /> LEACHING LINE [ ] Na. of Lines Len t,h of441��. _._J?�pth <br /> ach -line.;: - <br /> {•,�` ----�..... __ - ., � Filter Material ��.� �r ,'D' Box ..._.f Type Filter Material : --- .... <br /> - <br /> z Distance to nearest: Well '_..� .-...:.. Foundation; ..:.�. _ __:._.._.. Property Line :.. <br /> f <br /> SEEPAGE PIT [ ] <br /> -Depth, ----------- =---'-- Diameter _.-•--_•--=-. Numbers_._,:---.:-..----- .........Rock Filled Yes ...,No <br /> C] Cl <br /> { .. ... Water, Table Depth .................. _. - -.......... - ._.__Rock Size ............................ <br /> - <br /> {^Distance to nearest.- Well ` --- - ---.._... ....Foundation - Prop,-Line . .., <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .........:....... .•-_-:--_ ---•-- <br /> Date _ ... .. . ) 3 <br /> Septic tank (Specify Requirements) ........... "-- ---- -----------------•--•--- ---- ........... -••- ................ <br /> D4pos61 Field"'(SpdcifyRequirements) = = ..........:..... <br /> :_. ---------------- <br /> ...................... ........... <br /> .._.._............ ..... . <br /> - - -- .................-. a <br /> q <br /> ... <br /> (Draw existing and 're aired addition an reverse side)' ,. <br /> I!hereby certify that I. have prepared this application and that the work will 'be,,done in, accordance with Sais Joaquin <br /> County Ordinance3, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Horne'owner or;licen. k i <br /> sed agents signature certifies the following: F <br /> "I certify that:in the performance of the work for which this permit is issued, I shall-not:employ any `person in such manner <br /> as to become'subject to W kman's"Compensation laws of California." , <br /> Signed _.__.:_. y�°.. :.:..:._ ...... Owner <br /> er <br /> . <br /> - _ 4 <br /> Title � :�: ; <br /> ! {If other:than owner) 1 <br /> OR DEPA TMENT USE ONLY <br /> DATE' `.7 <br /> APPLICATION ACCEPTED BY .:.. ._. .......... ..........:... -----......... ............. -:............;..-- r <br /> BUILDING PERMIT ISSUED. <br /> --.........:._ . :.....::..._DATE,:..._.:__...:.._•-•-•--- -... . <br /> ADDITIONAL COMMENTS ........ .."••-:..................._........_..... ...........:-•............. .... _ ................... ..._•• -•-- • ....... <br /> d . <br /> ' -.....:..__ ---•--_. .. . .......---••••; - ••---.--.......'---•--_- -'� <br /> -----------------...... .. �.. ../... <br /> Final Inspection by: Dat <br /> .. •• .. - e .�. y <br /> SAN JOA IN L�CAI HEALTH' DIS`fRld <br /> 7/72 3 M <br /> E. H.1.3 24 1.'68 Rev. 5M - <br />