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FOR OFFICE USE, <br /> z APPLIZATION FOR SANITATION PERMIT �_ <br /> ...... . _ <br /> ....... Permit Nu. .7�_ X . <br /> (Complete in Triplicate) <br /> .......... ............................................. r 7 <br /> Date <br /> ....._................................................. This Par mit Expire% 1 Year From Date Issued <br /> Application is hereby mode to the San Joaquin Local Health District for a permit to construct and irotoll the .Pork hefein�; <br /> described.This application is made in compliance with County Ordinance No. 549 and existing Rules and kogulottansr <br /> JOB ADDRESS/IOCATION ........ y .........F 2 1.C.Ei-...L nmf-7....................CENSUS TRACT ...................._...'' <br /> Owner's Name �y / <br /> i..Q...........L. u..[\..2 ......................................... ............ ................ ....Phone <br /> Address .....:........:.5.0.�,.,,,.i-. ...,.a.....................:................: ..._.City ..FCe.Y.1.C..E'1......�a..Irv: ..-............. <br /> »._.r.7... ;r... <br /> Contractor's Nome ......License t1i .. � �..�.. Phone .N ' !KA...,. <br /> Installation will sorves Residence i3 Apartment Houso0 Commercial (Trailer Court 0 <br /> Motel(:]Other........................................... <br /> Number of living units,.....1...... Number of bedrooms .....�..i.—...Gorbage Grinder ............ Lot Size ....._.... <br /> ♦.K <br /> Water Supply, Public System and name ...................... ••••Private 13 <br /> Character of soil to a depth of 9 feet: Sand$J Silt❑ -Clay 0 Peat❑ Sandy Loom i] Clay Loom[]. � - sX <br /> Hardpan❑ Adobe 0 FII(Material..... ......If yes,type............................ <br /> `ye (Plat plan, showing size of lot, location of system. In relation to well , buildings, ate. must be plated on revw" side.) <br /> NEW INSTALLATION, (No septic tank or teepage ,pit permitted ifpvbik sewer is available wil�ln 200 feet,) <br /> r'ACYAGE TREATMENT ( ] SEPTIC,TANKA Size............��. 6� �,Q.:C�?...... Liquid Depth ........ <br /> q Capacity./20.4gaL Fype .�.......... Matarbal Co.ntl pl¢ No. Compartments ...19.L............... w . <br /> o ^ i <br /> Distance to nearest- Well .............L^..�� ..........Foundation.....f s'/ ... Prop. Line ....... <br /> LEACHING CNE O No: of Lines .........yl........:. Length of r-neh.. lint. ......... Total Length ...f.r.e., <br /> D ._... <br /> Disto neerosh e�Box ...... Type Filtet`Mahrlal ....................Depth Filter Material ........... .. ........ <br /> tante ........J;. <br /> W,1( fir.......... Foundation �.............. PrcpeLine ...rty Li ..;;2......._ <br /> P ......Depth Rock Filled Yes p No Q . <br /> ( <br /> Water fable Depth ............4...................................Rock Size .............. ................ ... <br /> Distance to nearest, Well ....i...................................Foundation .................... Prop. Lina ...................... :! - <br /> t�PAIR/ADDITION(Prov.Sanitation Pornit#.......................... Date ................................. <br /> ) <br /> Septic Tank 'Specify Requiremenls) <br /> Disposol Ftsld ISperify Requirements) ..........;..................................................—.................................................. <br /> :.,' <br /> .. ...._................._................................. ...:..:..:.................................................................................... ... " <br /> lDraw existing and required addition on reverse side) �L <br /> I herebf certify that I have prepared this application and that the work will be dot».in accordance with son Jett <br /> County Ordinances, State Laws, and Rules and Regulations of the Son Joaquin Legal Health DisMs:.Ham* 110"Of 6f <br /> sed agents signaturs.certl6ss the followings r <br /> "I certify thui In the perfarmanw of the Werk for which this permit is iuued, i shall not employ any person In such misevet <br /> as to become sub)aet to Workman's Compensation laws of California." <br /> Signed .... ... ............................ .._ ................................. .......Owner <br /> By ... ..1F.'. ! ..... .a.rt:w'L...LL.z_.c .._............... <br /> 71116 —.. e4l< k4±C-:4�:.U....... .. . <br /> (if other than owner,' <br /> $ FOi DEPARTMENT USE ONLY <br /> APPiICA':ON ACCEPTED Ry.... ...iati%-'�dt,`--....................._................................................. DATE ....v..-.:..Y.... ...3.......:.......' <br /> BUILOWGPERMIT IS.SUED..................................................................... ...................................DATE....................... ................ <br /> ADD)T'ONAL COMMENTS....._........... .............................................._..........................................................,.................................. ` <br /> ... ... ..................................................� . .. . ...... .. <br /> 'a Final Inspection by, .....,CZ..e...� ..c L ......I. ..I.............. Dob..... �;.fStcS//. . .... ... <br /> s� SAN :OAQUIN LOCAL HEALTH DISTRICT <br /> °. H.13 1-4 1--68 Rev, 5M F/72 3 'f '` <br />