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FOR OFFICE USE <br /> APPLICATION FOR SANITATION PERMIT _ <br /> Permit No S-6 <br /> ICompleto In Tnpllratel _ <br /> this Per nit Expires 1 Year from pato hewed <br /> Date Issued f 4, <br /> • Apphcot on is hereby made to the San Joaquin Local Health Dis•r ct for a permit to construct and install the work herein <br /> 4 describea This application is made to compliance with County Orainance No 549 and existing Rules and Regulationsr <br /> JOa ADDRESS/LOCATION fi vc 9d <br /> ,y CENSUS TRACT <br /> Owner s Name /1/�1 y �- ! c I' y/`3 Phone "/' SG l d <br /> Address ��)�;�('/ City I v"* :9 <br /> Contractors Name /',AeY/ h 0eVy ltf 5 —eV License 0 /Gb- ~�r�& Phone �A3� <br /> Instoilation will serve Resedence Apartment House 0 Commercial L-DT►ailer Court ❑ <br /> Motel (:]Other <br /> Number of living units Number of bedroomsGarbage Grinder Le-S-ze <br /> Water Supply Public System and name private <br /> Character of soil to a depth of 3 fret Sand C Silt Clay Ci Peat 0 Sandy loom Clay Loam is <br /> Hardpan[1 Adobe ❑ Fill irlatLr al If yes, type <br /> (Plot plan showing size of lot loc-ition of system in relation to wells bui'dings, etc must be placed on raverso side f <br /> NEW INSTALLATIONS INo septic tank or seepage p• permittea If public sewer is available within 200 feet) <br /> PACKAGE TREATMENT [ ) SEPTIC TANK[ J size 1:5- IF i/�.%{ ► Liquid Depth <br /> Capacity lae7e CV14 Type,/�' CF1517 Material "IV C No Compartments <br /> Distance to nearest Weil hL- Foundation -'eV' Prop LinolG'C' <br /> LEACHING UNE ( J No of Lines % Length of each line 7G Total length 3�� <br /> D Box j Type F,Iter Materic' [CIJ Depth Filter Mate,lal <br /> Distance to nearest Well CC / Foundation Property Line �C <br /> SEEPAGE PIT t 3 Depth Dfamete- Numbe Rock Filled Yea © No 0 <br /> Water Table Oepth Rock S+z9 C> <br /> M stance to nearest Well Foundation Prop Line _ Q <br /> P EPAIR/ADDITION IPrav Sanitation Permit* Date I <br /> Septic Tank {Specify Requiramentsl _ <br /> Dispo.ol Field (Specify Requlre-rtpntcl <br /> (Draw existing and required cddrtoon on reverse side) <br /> I hereby certify thor I have prepared this application and that the work will be done In accordance with Sart Joaquin <br /> C unty Ordinaneas, Stare Laws, and Rules and Rogulatlons of the San Joaquin Local Health District. Home owner or licen. <br /> s•d ogants signaturc cortifios 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 bosomar avblact to 1R1orkman's Compensation laws of California" <br /> Signed F•,l}�ry f /S u[! t� r.A Owner <br /> BY Jule <br /> Ilf othe!thZYmo erl <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCFFTED BYC� r.[ c i, d t•�-a G DATE —�2 <br /> BUILDING PERMIT IcSUED DATE <br /> ADDITIONAL COMMENTS <br /> Firfal Inspection by i' _ Date r <br /> SAN JOAQUIN LOCAL rIEALTh DISTRICT <br /> E H 12 24I 58 Rev 51x1 7/723 4 <br /> 13 <br />