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FOR OFFICE USE: <br /> APPLICATION FOP. SANITATION PERMIT <br /> (Complete In Triplicate) Permit No. 2................. f <br /> -..... ...-•---_..._._ This Permit Expires I Year From Date Issued 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 /> described. This application Is made in compliance with County Ordinance No, 549 and existing Rules and Regulations: <br /> .' ` • ••„r'.c-.:�s�,.--..r,-...{��.......................CENSUS TRACT ----.. ...... <br /> � <br /> JOB ADDRESS/LOCATION f ���. .� .,....r�.��..._�•.�'�:- � �. i <br /> Owner's Name/..., ted s' cyYK >.. ` '' '. .............. ................ •�T .Phone .�� �. s?C ....... <br /> Address ...-- ...`!__. ., Y I jam <br /> ------ ---------------- ------------ City ..... - --•-- <br /> Contractor's Name ..- ,_-- _ �f_ -•- - - . .........................:........license j# Phone --r-3,­.� <br /> Installation will serve: Residence❑Apartment Housef] Commercial❑Trailer Court fig--� <br /> Motel ❑Other-------------------------------------------- <br /> Number <br /> _Number of living units ........ Number of bedrooms --------....Garbage Grinder ------------ Lot Size S-0 <br /> --•-•-•-•--...... f <br /> Water Supply: Public System and name ............................................................ ......-.--...---.---Private r+k <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay 0 Peat❑ Sandy Loam fa Clay Loam ❑ <br /> Hardpan D Adobe tFill Mq#erial _ .....__:. IfYes,type -------=------- ------------ <br /> i • <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) q <br /> NEW INSTALLATION: INo septic tante or seepage flit permitted if public sewer.is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] ,j SEPTIC TANK Size-------------••--_---------..................... Liquid Depth .......................... <br /> Capacity e --------------­­ Material_--._................. No. Compartments <br /> Ll ow <br /> Distance to nearest: Well' ------------------------------------Foundation ------------_ . r <br /> Prop. Line ----___- -__,_____.---�/ , <br /> LEACHING LINE [ ] No. of Lines ------------------- ---- Length of each line............................ Total Length ............................1,,p <br /> 'D' Box ....... Type Filter Material ____________________Depth Filter Material ............................................ <br /> Distance to nearest: Well ------------------------ Foundation ........................ Property_Line _.-___._.......-�1 <br /> SEEPAGE PIT Depth .............. <br /> Diameter ----__.......... Number ............................ Rock Filled Yes ❑ No i❑ . <br /> Water Table De ---------------------------------------------..-Rock Size -..:_........................... <br /> y <br /> I <br /> Distance to nearest: Well .---------------------------------------Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# •------------------------------------------- Date ........._- ......... or,- <br /> Septic <br /> r`Se tic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) - - s. ........a­..?/a --Q,...... .;e .............................,6 pp <br /> ----------------------------------------.,._.- -. -•- -- ----------------------------------- ­--------------­----- ......... ------------------------------........................ <br /> I <br /> --.•------------------------------------------------------------------------------------------------------------------------------------------------------------------•.................................. <br /> (Draw existing and required addition on reverse side) r <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquln ` <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or liven- I <br /> sed agents signature certifies'the following: <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 Workman's Compensation laws of California." <br /> Signe i! <br /> -----._ ---- --------- •---• ---=' -• ---- ------ Owner <br /> _.,c,�-- - w ---- -,-- Title ,.. <br /> 8Y <br /> {t otherthan o er) r <br /> FOR 4?EPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 8Y,,.--- --_-_. DATE ..-. -- -- -- - -.-...:... <br /> BUILDING PERMIT ISSUED -- ------ ----------------------------------------------DATE ----------- <br /> -- --------------- -------- <br /> ADDITIONALCOMMENTS ------------- -------------------------------------------------•----------------------------------------------•------- ----------------------- ---------------- <br /> ---------- .............._--------- <br /> --- = - -------------------------------------------•----------..........---•------... _.-.---••-------- <br /> /1- <br /> final Inspection b _ .. .. .... ..... ... ....... . .. ....... ........ ...Date ._.. . � ._.....--. . <br /> 2�t 1'68 Rev. SAN JOAQUIN LOCAs. HEALTH DISTRICT 8/7h 3M r-ZZ, � <br />