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FOR OFFICE USE: <br /> APPLICATION FOR--SANITATION PERMIT <br /> ----------------1� ----- ---------------------------------- A <br /> r (Complete in Triplicate) Permit Nd k <br /> ---------=----------------------- ----- Date Issued -------- <br /> 6 <br /> -------------------------------- ------------------------ This Permit Expires I Year From Rate!Issued. <br /> Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is made in complici-ndeNvitli County OrclWpnce No. 549 and existing Rules and Regulations: <br /> -. 7 1" <br /> -- <br /> JOB ADDRESS/LOCATION -- <br /> -- --- ----------- CENSUS TRACT ----J�------------------ <br /> Owner's Name ----------- -------------I--------------------- -------Phone ------------------------------ <br /> Address --------------- > <br /> ------------------- City ------- ------------------------------ ------ 1 <br /> Contractor's <br /> -------------------------------------- <br /> Contractor's Name I --------- Phone------------------------------ <br /> -- <br /> R--------------------------------------------------------------License # ---------- <br /> J^ <br /> Installation will serve. Residence F] ApartmeAt House❑ <br /> Commerclal,dTrailer Gew*- <br /> Motel_MOt lie7---------------=-t------------------=----- <br /> Numb <br /> --------------t-------------------------Number of living,,units:--- ------ Number/of -.Garbage Grinder ---1V0__ Lot Size _-ACA ----------- <br /> Water Supply: Public System and;name"-------------------------------- ------------------------------------------------------------------------Private <br /> Character of soil to a depth of 3 feet'�7,',,�Sande Silt S,Clay El Peat E: ] Sandy Loom -D , Clay Loam E3 <br /> Hard -E] Adobe 0 Fill Material _WD, --- If yes, ❑ <br /> type ---- ---- ------- ❑ <br /> ---------- <br /> (Plot plan, showingFsize of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> j <br /> PACKAGE TREATMENT SEPTIC TANK Size____--9-K---�?_X5--------I------- Liquid_D(�pth------* <br /> Capacity ---- Typetkif__07M!----- Material No. 'Compartments ------------------ <br /> Distance to nearestz,.Well -------------------Foundation _16------------- Prool.Line -------_4'�o <br /> LEACHING LINE No. of Lines --------- ------ Length of each line------ ------------- Total Length --------------- <br /> je <br /> Depthi Filter Material y <br /> 'D'. 136k &.0------ Type. Filter Material. -------- ----------­­­------------- <br /> Distance to nearest: Well --------------- 1 _ Foundation ---------------/0-- 'Property Line ----------------------- <br /> SEEPAGE PIT Depth'_`------------------ tDiameter ---------------- Number ._/ '---------.---------- Rock Filled Yes 0 No <br /> WaterjableDepth ------------------------------------------------Rock Size -------------------------------- <br /> Distance,to near6st: "d----------------------------------------Fou'n' <br /> i2wdation -------------------- Prop. Line ------------------­-- <br /> REPAIR/ADDITION(Prev. Sanifa tio"n Permit# <br /> -------------------------------------------- Date''.------------------------- -------- <br /> Septic Tank ISpecify Requirements) ------------f_-1 -------------------------------------------------- <br /> --------------------------------------------- - ------------------------- <br /> Disposal Field (Specify Requirements] ------4 1 AJ-JE�-------VAJ IF-R E!—'- C N-M ft Ei�,D-------- <br /> t A- <br /> ----- <br /> -T-Ht5_____WORK----_14445o_--- r-JF, A- Cid- T ----Iff-5------C-bA44Pkr—T-f—=D------13 OwT_­_-NOT--------------- <br /> (Draw existing and required addition on.rev'erse side) A P P Ro V r-_D, P\ <br /> I hereby certify that I have prepared this application and that the work Will be done in accordance wit-fi-3—anloolqu <br /> County Ordinances, State Low's, and Rules and-"Regulations of the San Joaquin Local Health District. Home owner or licenJ <br /> - <br /> sed agents signature certifies the following: <br /> "I certify that in the perFormarice of the work for which this Permit is issued, I -shall not employ any person in such manner <br /> as to C becomes yMe ct toWVVoykman1s; onjpe sa- <br /> . n 1. Ron laws ?California." <br /> _ <br /> Signed Owner'� <br /> By -------------------- ----------- ----------- Title -----%''-------�!----------------------------------------------------------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> 7 <br /> DATE - --- - -- -------------------- <br /> APPLICATION ACCEPTED BY ^` --------- -------------------------------- ------------------------------------- <br /> BUILDING PERMIT'-ISSUED—­-_!�_:-------- --------------•-- --------------DATE ... ---------------=----`------------------- <br /> ADDITION CO 0ENT --- -- ------- ----- ----- ----- ------------------------------------ <br /> A -- ---------4 <br /> 44� _W.7 --------- <br /> ---------- ----------- <br /> A <br /> ---------------- ------------------ -- <br /> --------------------------------- -------- <br /> - ----------- ----------------------------------------------------- ------ <br /> . r- <br /> ------ ------ <br /> -by- __.Dat <br /> Date ...... .... <br /> Final Inspection <br /> �SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i-e E. H. 9 1-'68 Rev,.5M <br />