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FOR OFFICE VSE: <br /> ­_--�`APPLICATION FOR' <br /> SANITATION PERMIT <br /> ICornplete In Triplicate! Permit No. .•.7`S' S3 <br /> ., _ ... <br /> y <br /> . This Permit Expires I Year From Date Issued <br /> Date Issued " •-Y--f <br /> Application is hereby made to the`San Joaquin Local Health District 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: <br /> { CENSUS TRACT _ <br /> JOB ADDRESS/LOPAV <br /> ION i . s�.�.. <br /> Owner's Name .. ._ .� 4.r_Q_Jf!! 't! Phone ... <br /> 4 <br /> .....i .. -•---- .. - <br /> Address .D�..�..�} �••---------- - -•_`.._ito •--------- ................................City . .L l .. e4li/ ---------------------------- <br /> Contractor's Name <br /> t ......................................................._........License # .----........- ...__--- Phone l <br /> Installation will serve:.4.. Residence W Apartment Housefl Commercial QTraller Couit 0 <br /> • s 9 <br /> } - _Garbage Grinder Lot Size ' <br /> t Motel Other t \ . <br /> Number of living units:....:'---------Number of bedrooms <br /> L _ <br /> Water Supply: Public System and name .._•-......--.Z--1---- --------- -----------......-........._......................:-------------------Private ❑ `t <br /> Character of soil to a depth'of 3 feet- -Sand Q Sift Q Ciay Q Peat[] Sandy Eostm Q Ciay Loam Q' " t <br /> :. � <br /> Hardpan 0 Adobe Q Fill M6terlal If yes,type <br /> ..... ... ............ <br /> r (Plat plan, showing size of lot, location of system in r+alation to wells, buildings, -etc. must be placed ori reverse side.)... v <br /> NEW INSTALLATION: -(No septic'tank or seepage pit permitted if public sewer is available within 200 feet,( f/ <br /> PACKAGE TREATMENT 1[ SEPTIC TANK£ Size................................................ Liquid Depth ....4_y2�__---------- <br /> tents Capacity -� ?•.__._ Type --------------=----- Material :.._ No. Compartm .. <br /> Distance to nearest: Well ____________________________Foundation ...................... Prop. Line ......................cfof <br /> LEACHING LINE [ } Wolof Lines .--....1.:.............. Length of qpch line....................._._..... Total Length -- .......... (A <br /> I'D'(Box ...... Type Filter Material . .__._ -- <br /> YF a�'Ir----.Depth filter Material .....�,�.i................................... - - . <br /> Distance to nearest: Well ....... . ........ Foundation ....../a -- Pro a Line ... ............... <br /> SEEP` AGE F eapth ...�. --------- Diameter .. .--- - ---- Number ...... ........ Rock Filled Yes No 0 <br /> Water Table Depth ----............................................Rock Size ............................ ------ <br /> 'Distance to nearest: Well *11-7Z.-A ..............Foundation. ............: - Prop. Line ,��.. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .................................�....... Date ........................----------) <br /> Septic Tank (Specify Requirements) . . <br /> _ 4 �_ . • . <br /> Disposal Field (Specify Requirements)•••.. ...... ..... _x._. -__-: _---. m-----.------•-•.- f-----------------•----•- �....... -. <br /> ,. �.� _ <br /> ------------- -------------- -• ---------------­-----._............. ---•-...................................................:..........=-......_..................... <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work milli be done in accordance with San Joaquin <br /> 4 County Ordinances, State Laws, and: Rules and Regulations of the Son Joaquin Local Heal&District. Home owner or Ilcen- <br /> sed agents signature certifies the following: <br />` <br /> 'I certify that in the performance of the work for which this permit is issued,' ] shall not employ any.person in such manner <br /> as to beco bt ' Co ern laws-.of Califar <br /> Signed . niaOwner <br /> - <br /> ,_� <br /> By ..--... TEtie .. i - 1 r <br /> T---------... ---- -•..._.__.._ ------------------------_--- <br /> I <br /> -- - <br /> ff other than owner) <br /> PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY/-- } DATE f <br /> BUILDING PERMIT ISSUED ... .. ...-: - ...............DATE <br /> ADDITIONAL COMMENTS --- .. ..... - -- ----- ------ -- <br /> ---------------- - 'L? r ------------- ..-.- ......... ------• .......... <br /> ` -- _8�-�- <br /> -----------------•�' '` .-----•-------•- ----------...... <br /> Inspection b _... . .. ' - <br /> : .. ---------..•...•.... ...Dater---- . . <br /> final y <br /> EH 13 1-6 lI� SAN J AQUI LOCAL HEALTH DISTRICT 7h 3M <br /> I <br />