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aApnICATION FOR SANITATION PERMIT Permit No. . <br /> w ...-••--•-................... {Completeln Triplicate? <br /> .`.........a........• m Date issued7' <br /> ....................................... �. <br /> This Permit ExRires i tear From Date issued <br /> Application is hereby.made to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> i'p -'In coin licance wifh Couhty O-dinance-Na:544 and exciting'Rulai'and Regtalationsc f <br /> described. This npplieatlan is made ... <br /> (j � SUS TRACT <br /> # T N --••�� �.��....... � .. N ... S <br /> JOB ADDRESS/LOCA 10 �� . ............Phone <br /> r Owner's Name �_.t :......_ . <br /> .................. ............ ................. _ 1 <br /> �r . . rC L� .city r-,.---CA ._ ... <br /> Address ....._ -.l--l.�a. - . ......__:....................................city <br /> Phone,•��--=lGf1�..... <br /> r �G .. .................;............ <br /> Contractor's Name ...-=•• • •J-�'-�• •••-u <br /> Installation will servo+ Residence Apartment HouseC3 Commercial oTraller Court ❑ <br /> r Motel (]Other...... ............ ....................... `� � ...... <br /> s s ...........Garbage Grinder ............ Lot Size ... !-................. -• <br /> Number of living unitsc. _�.----- Number of bedroom ...............................Prl" i <br /> Water Supply Public System and name ------......5- t .Clay . Peat a._...SandY Loom Clay;Loom Q <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Y ❑ ......... ....... . <br /> Hardpan 0 Adobe❑ fill Material .. .........If yes,type ..t.. <br /> f ;." laca3d an reverse side.) <br /> iPlot plan, showing size of lot, location of system to re)atlon tor, buildings, etc. must be p l <br /> k alloble within 200 feet,) <br /> p- er is av <br /> ` e it ermined If public d�eM► <br /> E NEW INSTALLATIONS • (No septic tank or seepage p P .....r` , fr, ... <br /> . �gX X1- '` <br /> Size-15...... . .:. -y... . Liquld Depth <br /> PACKAGE TREATMENT [ ] SEPTIC TANK arfmants ..-Al. ... <br /> y CAfi�Material. 1, 1•C:-`:... No:'Comp <br /> Capacity af. lCxL?••-•-- Type a PropLine ........... . . -••9 <br /> .Foundation ..................... • ' <br />�• � <br /> Distance to nearest: Well ............;........................ �t�.:�' . Total Length .�l�•--•......... <br /> N f Lines-•••••---....._.. Length of each line. h N <br /> LEACWING LINE [ ) o• o ptltzfilter Material -Ap.'•• ................ ...:.. <br /> k 'D' Box .. .:-..... Type Filter Mata�lal ,?t f�.f..... property Line <br /> We1i� ._Faun nit �..� r. <br /> Distance to nearest, �w Number_' ..................... Rock Filled Yes ❑ No 010 <br /> SEEPAGE.PIT ' I ) <br /> Depth ..... Diameter ... .. :p-: .......Rock Size ........'................. . fr <br /> Water Table Depth .................... :. . . .... ..... Prop. Line ............:.... <br /> G Well __... ..............................Foundation ..................... .. { <br /> i?Istance to nearest: ' ! -) <br /> REPAIR/AADITION(Prev. Sanitation Permit .. _.. Date .. ...-: .-- ...,.... ...,........—1........... <br /> Septic Tank (Specify Requirements) .... ' . .f. ........ ..... ..............................»- �..... ...........---• •- . <br /> l7 sposai Field (Specify Requ€reme t i .............. ............................................................ {. .................................................. <br /> ......_ ._.._........ _....__.....__... <br /> :-- <br /> ' ...... -.---•----- .. <br /> - ........................... .............. <br /> _.:....._-._.. ----• Draw existing and required addition on reverse side) <br /> t ' <br /> i <br /> t hereby certify that t have pirepa►ed this application and that the:work with bf dem 1n acterdanee with �n 1a04+ain <br /> 4- trounty,�Ordinaees, State Laws, and Rule: and'Regulation s of the Son Joaquin Local Health District. Hone gwner er t1ceR- <br /> sed agents slgnature certifies the following: _ ! t { ermit is issued. I shalt not ernpley any person In such manner <br /> . <br /> ` i certify that to the performance of the work for whlch t s,p <br /> as to beoineIsvb(` to orkman's Compensation laws of California." <br /> / � ner <br /> _- OVV <br /> " }�`"Jitle `: ................................................ <br /> IA <br /> By ..-.. .... ll€ othe(thon owner)�� �n..=� ��:., — — ----- •.- — ---=-�� �_ ."'."'"`"'. "" ` .r <br /> � - <br /> -.. - ----w-.-- r_ <br /> DEP ENT USE ONLY <br /> - R <br /> .. ......... D �37 <br /> APPLICATION ACCEPTED BY '..-- "° ' <br /> .............. ........ <br /> :..........'.._.........._........ D :...:.. <br /> BUILDING PERMIT ISSUED ..... ... .... ............. ..... ••. <br /> • ADDiTIONAL�COMMENT5--.':. ....:.-•...- . . .: :.... ... .................... ---.. -- --•- <br /> t r' i .` R <br /> :.. - <br /> --- .... ...... <br /> -. ..... <br /> ...._. ........-p...... 1........... ............ . ........-..-......-.........-...... <br /> ...r--:... �---- •---... --- <br /> Final lnspectiari�y . <br /> LH,,/13 24�1L68 ' 5M- SAN JOAQUIN LOCAL- HEALTH DISTRICT aI7� � <br /> 1 <br />