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FOR OFFICE L15E s <br /> 41APPLICATION FOR SANITATION PERMIT 7S- <br /> ......... ....... ..... . <br /> ?• IComplete�in Triplicate] <br /> e ti <br /> f Date Issued ..�.............. k <br /> .............................................I.,........ This Permit Expires I Year From Dotels:vee! <br /> Application is hereby made to the San Joaquin Local Health District for pp Y q permit to construct and Install the .work Derain <br /> described. This application is made in compliance witN County Ordinance No. 549 and existing Rule` and Regulations: <br /> JOB ADDRESS/LOCATION .. -- :: _ .. ':_.C:'. ._ .`. ` t..... .. .:.`° .." .. 72INSUS TRACT ......... ................ { <br /> Owner's Name _.6 <br /> ..� • • . ' ---•--' 1......................................................................Phone ......... .......................... <br /> Address . ._.,... , <br /> 5 2 ._. . ...... City ......3.............. ............ ....... <br /> Contractor's Name .. .........License # !.✓� �i'�� � Phone <br /> Installation will serve: Res Bence Apartment House Commercial-❑Trail_' Court 0 <br /> Motel ❑Other _..._ ...............*.•- --•- G <br /> Number of living units:...... Number of bedrooms ..¢ ....Garbage Grinder ..-.......... Lot Size .. .... .. .................. <br /> Water Supply: Public System and name ....-.................................................................................................:.......Private ❑ <br /> Character of soil to a depth of 3 feet: Sand b Silt[] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loans <br /> .Hardpan❑ Adobe ❑ Fill Material if yes,type ` <br /> (Plot plan, showing size of lot, location of.system in.relation to wells,..buildings,._etc._.must be placed on reverse side.] s <br /> NEW INSTALLATION: .�..(No septic tank-or..seepage=pit-permitted 4f publlc-sewer is-available"within 200 feet;) <br /> PACKAGE TREATMENT [ J SEPTIC TANK .J s-» Size._.,. ---•---........I............ ."... Liquid. Depth ...................... <br /> Capacity Type Material..- -_:.... No. Compartments <br /> .t. J <br /> Distance,to nearest: Well ....................................Foundation ._-............_...... Prop. Line ......................r I <br /> LEACHING LINE [ j k No. of Lines ..J.......... Length of each line.... .:. Total Length -c-5U................. S:' <br /> i 'D' Box __.... ..... Type Filter.Moterioi ..r..............Depth .Filter Material ........... ..... <br /> f <br /> ' Distance to nearest: Wellf..................... 'Foundation ............ ...... Property Line ........................ <br /> SEEPAGE PIT Depth �� 1 7" 1 �] <br /> I p �(gk.. __. Diameter ---------------- Number .. ......______._.__•€._... Rock Filled Yes, ] No <br /> Water Table Depth ...-- ----•---RockSize'...':_..::; •--••- <br /> Distance to nearest: Well .. _...........:......................Foundation .___........_.......' Prop. Line 10----_------- <br /> k <br /> REPAIR/ADDITION)Prey. Sanitation Permit# .............-------------------------------- Date ...........:......................I <br /> SepticTank (Specify Requirements) •----------------------------------- --------------- ........................................................................... <br /> { <br /> Disposal Field !S ecifY._R_e ire. ents. <br /> I <br /> ....------- -------------------•------ :� --:—w- _ ......... ---------••-------- <br /> . <br /> (Draw existing and required addition on reverse side) 4 <br /> I hereby certify that-1 have prepared this application and that the work will be done in-'actordance with San Joaquin <br /> County Ordinances;;$tote Laws, and Rules and Regulations of the San Joaquin Local Health,Dist4c Home owner or Ilcen- <br /> sed agents signature certifies the following: f '-- - <br /> "I certify that in the performance of the work.forwhich this permit is issued, I shall not empioy�"any person In such manner <br /> as to become subject to Workman's Compensation laws of California." -- <br /> F - �} <br /> Signed weer <br /> ----- ------------------•--- O <br /> BY [�= '� -------------------- title ..... --..... ----- ......'._�'....-........ ---------- <br /> {I o#her an awned ; <br /> _ FOR DEPARTMENT USE ONLY42 <br /> APPLICATION ACCEPTED BY - - _..__.._DATE . _- h_ .:.... <br /> BUILDING PERMIT ISSUED .------------------------------------------------ <br /> TM- -- -- -= = ry�.�-;.- ' .......... DAVE.............................................. <br /> ADDITIONAL'COMMENTS .................. #_. <br /> V <br /> ............................. ................... ........ ........................................................................................................ ................................... <br /> -------------- ---------------- <br /> -»...-.----- _. ------- ------ ..--- <br /> _.,_.____ „�„ _ .... . ffd-..fie.-,..._ <br /> Final Inspection icy: .---- ............ ----------------_--- --------.------....._-----------------..Date . ?-- -- ° ..._....................... <br /> EH 13 21a 1-68 v. SM SAN JOAQUIN .LOCAL HEALTH DISTRICT 8/7h 3M <br />