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c FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ICompiefe in Triplicate) Permit <br />' Th{s Permltfxp{res 1 Year From Date issued ate:Issued�° <br /> �+ <br /> Pow <br /> Application is hereby made to thwSaw.loaquin Local Health-Districf 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-1 <br /> JOB ADDRESS/LOCATION > <br /> -• --..,�.............. ...........,..CENSUS TRACT ........,._................ <br /> Owner's Name ...... !. ................................... ....Phone ........................... <br /> Address ._... /OU?1...,65.... ._Pi�r_1e-.*....i'Jr - Ci lF. ... <br /> , • <br /> Contractor's Name --- License Phone ' <br /> :-. -- <br /> Residence©Apartment•-...---•-----.:...-•--•- ---•................ .............-..__....... <br /> Installation will serve: <br /> i• .-- House t] Commercial OTrailer Court 0 <br /> Motel ter:._'.. F ISP ..........._ <br /> Number of living units:_.- Number of bedrooms Garbage Grinder Lot Size :.:...........:... <br /> Water Supply: Public System and name _._.....__,• -- ---•-- •---•---..: <br /> ...............:....................... <br /> I <br /> ....Private Q 4 <br /> Character of soil to a depth of 3 feet: Sand TR Silt Q Clay ❑ Peat❑ Sandy Loam:❑ ' Clay Loam ❑ <br /> Hardpan p Adobe 0 Fill Mpterial yes' type <br /> If ' <br /> if F , .. <br /> Mot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.} <br /> I` NEW INSTALLATION: (No septic,tank or seepage pit,permitted ifpublic sewer.is avo ilable within 200 feet,' <br /> I IC TANK I l t Size..--•--=----------- -•-• ......._........ Liquid Depth ...................... --- j <br /> I <br /> PACAGE TREATMENT SEPTI <br /> I Capacity --- ,-- ..... Type - Material. No; Compartments .. <br /> r - <br /> Distance'to nearest Well :` 77- <br /> Found' n � <br /> at€o `_ Prop:•Line <br /> LEACHING LINE ;[ ] No. of,Lines _�; Length of each line. --,_-:...... Totcl Length ............ <br /> oQ <br /> 'D' Box. -. Type Filter: Material -- i {;? Filter Ma erial . .......................+ l .. .... I <br /> F <br /> . Distance to nearest; Well i i' <br /> . . . .. <br /> Faunda#'on Property lin ................ <br /> SEEPAGE PIT `[ ) Depth ...-- _ Diameter Number o <br /> ; a <br /> i s Water Table 'Depth <br /> "" :`.Roc Fie Yes N <br /> b Rock•Size ❑ <br /> 1 d r ; o <br /> .............. <br /> i. Distance to.nearest.,Well ,_- _-. n } op.'-Line ...,--- <br /> :.:. F <br /> ou dot on Pr <br /> REPAIR/ADDITION{Pre . _._ .y. Sanity#ionPermit # <br /> i .. _. ©ate._..... }...... . . <br /> :__.•._ <br /> l Se tic Tank (Specify Re �uirementi sf --:--- ,- j: r <br /> Disposal Field � J <br /> (Specify .Requirements} --..:...1. _-- <br /> r, . <br /> ----- <br /> I G�1�ccrje -- .._ J <br /> .:-_---------•------------ -' �._..__ _ <br /> - - .. ---- -- - - _•. - ... .. <br /> , d <br /> ` - ---r - - - -�---—---• , - - - �...• . :----..c_....a......:......i....-........ ... <br /> ca <br /> y P P pp nd required addition on reverse side}- - . <br /> o- g <br /> Coven r` raw:apple on,and;that,tha work•will be done,in pccordante,wEt_h"San..Joagriin <br /> t r <br /> I hereby cerci that l;have re tired this application <br /> ty O dinances, State Laws, and Rules. and`Regulations of f he'San Ioaquin'Local Health:Dishich Herne owner ei Iicdn- <br /> sed agents signature certifies the following <br /> "1 certify That in the performance'of the wcrk-fbtwh{ch thii permit-is issued, i.sha{{ nok employ pny;person in,such manner <br /> as to bete a sabject to Workman'' C na on laws offCahfornia ' <br /> Signe <br /> I # , <br /> t <br /> r <br /> BY .......... ....... ... ......_...._......-_.______.._.__._ _...'___ <br /> - --- = Tit e ` <br /> . r <br /> if other than'owned A µ <br /> f FOIA:DEPARTMENT VSE ONLY r, ! <br /> APPLICATION ACCEPTED BY t <br /> - <br /> r <br /> DATE. <br /> BUILDING"PERMIT' ISSUED- --'77'7,-"-. `-•------------------------------ •- . ---- DATE , ..._ ...... -----7---7--"- <br /> ADDITIONAL COMMENTS --------- i ----------••-- <br /> i <br /> - <br /> •--------------------------->-- ....----•-•_.. ---------------------------------------- <br /> -----•--- -----•-•---•---•----------.- ------ ---••- .------- --.----. <br /> .:....... ... � <br /> Final Inspection by: 0­0 Date ..-- • <br /> EH 13 24 1-68 itev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />