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ap1q 'y ti?�rrytrra _ , <br /> FOR OFFICEU..E � l� <br /> e ! ` <br /> : I APPLICATION FOR SANITATION PERMIT' �l l <br /> PermiT No. . <br /> (Complete in Triplicate) <br /> s ' <br /> ............................... ...... Data <br /> ._.PP <br /> This Permit Expires 1 Year From Doti Issued <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to construe and install the work herein <br /> described. This a hcallon Is made in compliance with County Ordinance <br /> No. 5540 and existing Rules and Regulations, <br /> JOB ADDRESS/LOCATION — F / -.- .CENSUS TRACT ..'•^." <br /> '' -....... ..... <br /> 40 <br /> Owner's Name ........ ...... .... _. . .. Phone - <br /> Addresr ....... .............. ......... �/ M <br /> x� � i # , SO/ .... Phone .7r'+o ..... <br /> Contractor's Name +., <br /> installation will serve: Residence7Q Apartment H�ppouseQ commercial❑Tro.ln Court Q <br /> Motel ❑OtherJr..47[ ................. <br /> Number cf living units:............ Number of bedrooms ........Garbage Grander .... Lot Size ............... .. .... ... <br /> Private❑ ;• <br /> Water Supply: Public System and name .................................... "'.""'-'""'""""""'..-" ". <br /> Sand Loam Cloy Loom "7 <br /> ' Character of soil to a depth of 3 feet• Sand Q Silt❑ Clay ❑ Peat❑ Y ❑ Y L - „ <br /> t yo a............... <br /> ,. Hardpan❑ Adobe Q Fill Material............If s,type .."..••"��-�� <br /> (Plot plan, showing si.a of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATIONt (No septic tank or seepage pit permitted If public sewer is available within 200 feetJ 7, <br /> X a <br /> PACKAGE TREATMENT [ ] SEPTIC TANK( ] Size........................................ Liquid Depth .....................,.... <br /> Capacity .. Type .................... Material...................... No. Compartments ............:.........W <br /> Distance to nearest: Well .....................Foundation. ............. .. . Prop. Line.. •.. <br /> eFA.CHING LINE ( J No. of Lines .. ........... . leniih of each Ilra .. -. . ...... Total Length . ... ... <br /> 'D' Box .... . . . Type Filter Material .. Depth Filter Material ., <br /> Distance to nearest, `Nell . . Foundation Property L!ne <br /> ..... ....... .... <br /> SEEPAGE PCT Depth Diameter ........ Number ....... . ................ Rock Filled Yes ❑ No O.�, - <br /> Water Table Depti: ...............................................Rock Size................ <br /> Distance to nearest: Well .... ....................... .... ...Foundation ... ................ Prop. Line .................... <br /> REPAIR/ADDITION(Pre". Sanitation Permit# ate ...............................1 <br /> `- 6eptic Tank (Specify Requirements) ...�. I �..t,�-� "'l.Ba"" Q � �• <br /> *16=,isposol Fiold (Specify Requirements) - L --rs�` ""' ' <br /> ........ . .. ,�---'c. ... . C't ..yolk / X.Cr.TL.�Y. ,ri�....... ................... . ..,. <br /> ''- . ................................ .I..... . ..... ... ...... ........ .... <br /> ..... . .......... ... ... .... ... .. <br /> ...... . .. ....... ... <br /> (Draw existing anti required oddltion on reverse side) <br /> I hereby cerci/y rite) 1 have prepared this epplimtlan end the the work will be done In accordance with San Joaqn <br /> ui <br /> kw; ulation eC tits San Joaquin Local Health DlsMer et. home ownor Itc <br /> County Ordinances, Stata Laws, and Rules and Regen- <br /> _ <br /> sed ogents signatum cwtifiec the Following: - <br /> +�yl� "1 cerci!!;that In tits performance of the work for which this permit is issued, 1 shall net employ any person In nueh manner <br /> as to become subject to Workman's Comaensatlon laws of California." <br /> Sigred ...... ... .. . ........... Owner r^� njh <br /> a; .'..... ....... ...... ........... Title. . 'l �...... . ............ ..... <br /> S <br /> ........�.�.� t <br /> Py . <br /> ����pf other n owner) <br /> FOR,DEEPAARRTMENT USE ONLY <br /> APPLICATIOI! ACCEPtED BY........ . ... . :.../� Chu^—'................. ..... . ... _.. ........ DATE ....,1..:?a'.'..�r...... ...... <br /> BUILDING PERIAIT ISSUED.........._................._..._................."..,...._...._........................... .......DATE .......... ................ .... .. .._ <br /> .... ...................... <br /> ADDITIONALCOhIMENTS......._.............................................................................. .. ........................................... <br /> - ._.............................................................._................ ......................................................................................_....• <br /> gY- J ...... ........ <br /> .............. eCt-:1-on-... ...... . .........Date ..-�'.......... . <br /> Final Inspection bye ..... .. ... ...a. s.,.-....... . . . .......... :.. <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 7.'08 Rev. S.M <br /> I <br /> FAi <br />