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FOR OFFICE USE: <br /> 11/r�/� • ............./.! 3 °.... <br /> APPLICATION FOR SANITATION PERMIT <br /> '+ (Complete In Triplicate) PermM <br /> ......................................................... . This Permit Expires 1 Year From Date Issued <br /> Date <br /> Application is hereby made to the San Joaquin Local Health District_ for a permit to construct and Install the work hereii <br /> described. This application is made in compliance withCountyCounty�Ordinance No. 549 andel existing Rules and Regulations: <br /> JOB ADDRESSAOC�AAT--I--ON ....;?4....141../.f� fl�LtlSi. A':.... 65i .!l _ US TRACT ......................... <br /> Owner's Name ..�y�-1!✓.�1 ...T // § ............... <br /> Address ....... ---. .M!% �"''$... ................. City /!� -................... <br /> _ .-/ ..... <br /> Contractor's Name. % 'T2.i[.... F1cl l .. TY.G'. ..............Llcense fF "??11144. Phone 06640,Xa <br /> Installation will serve: Residence ❑Apartment House Commercial ❑Traller Court ❑ <br /> v <br /> Motel ❑Other .... F.St' C rtA!�2..'.......... / <br /> Number of living units:............ Number of bedrooms .....•?'`Garbage Grinder ............ Lot Size ...[.-. ............. <br /> Water Supply Public System and name .. ...........................�---.......--•:..... ...................... ...........................Private <br /> 'Character of soil fo a depth of 3 feet: Sand SiM.(3 Cla.� Q Peat❑ Sandy Loom Q Clay Loam ❑ <br /> xt� '; •1 <br /> Hardpan Adobe _ 041 Material ............ If es, <br /> P ❑ 1] .. Y type ............... ............ <br /> (Plot plan, showing size of lot, location of system in relation�to wells, buildings, etc. must be placed on reverse side. <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted if.public sewer is available within 200 feet,) <br /> i PACKAGE TREATMENT SEPTIC TANK —Size. ~ <br /> [ ] '\ '�'.,J�f,Q//...++.........................liquid-Depth ...s�................ <br /> ( Capadty _11QQ..... Type .t�i ;. Material.L6W........... No. Compartments .._ 1........ <br /> ( Distance to nearest: Well _4_00............._.-...-.Foundation ---/..8..-.......... Prop. Line .....,7~—..:........ <br /> 1 i <br /> LEACHING LINE ) No. of Lines ......I............... length of each line..-.-�f0.............. Total Length .:...70............. <br /> r ' ` D' Box ... Type Filter Material /. .. X fC..Depth FiltePMaterial ..... �.�:............1.......... <br /> Distance to nearest: Well .. .....a..... Foundation .../GL............. Property Line .. . .............. <br /> SEEPAGE PIT ( J Depth .................... Diameter ..........:..... Number ............................ Rock Filled Yes ❑ No <br /> Water Table Depth -•......................................_......Rock Size ............................ I <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ..................... <br /> REPAiR/ADDITION(Prev. Sanitation Permit# ...............................:............ Date ..................................I <br /> Septic Tank (Specify Requirements) ...:.........................._.............._.........._.....................................................:........................ <br /> Disposal Field ISpecify Requirements) ..... ....................................................................................---.....---............................... <br /> T ............... <br /> I ...................:y...................----•----------•-------•----------------••-------•------•-----.............................. --- --•••---..............••---......7......................... <br /> (Draw existing ond-required-oddition on reverse side) <br /> i I hereby certify that I have prepared this applicatlon and that the work will be done in accordance with San Joaquli <br /> County Ordinance's, State Laws, and Rules and Regulations of the Son Joaquin Local Heallh.Distrld. Home owner or liven <br /> f sed agents signature certifies the following: \ r - <br /> "I certify that in the performance of the work for which this permit is Issued, I shall not employ any person In such manna <br /> as to beco subject to Workman' Compensation laws of Califorr'ti'o." <br /> Signed -_.. ._. -4i, .i. Owner <br /> By ----- rifle ---. ... .- --.. ..M"."......... ......---- <br /> -....-._...._....... .. _...- - - - - - ---------------- .. <br /> If ther an owner) <br /> PARTM ,T USE. ONLY r. ... _....� <br /> -- <br /> APPLICATION ACCEPTED- B :.. DATE . ..:.l.I_7:1(.'.7 ........ <br /> BUILDING'PERMIT"ISSUED .:. .._-...... ...... <br /> .. .catvitt.eT . . `... <br /> ADDITIONAL COMMENT$......._. ................ ....... ..y.. � aATE .r..'..i.-.v-...... <br /> . <br /> ................... ......... <br /> f <br /> ....................... ........................_................:............................................................................................................ <br /> .....,..... .......... <br /> ........ ..... <br /> FinalInspection by: .......... ........... ...............................................................................Date .../l ....... ..... <br /> EH 13 24 1-68 Rev. 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 8/711 3M- <br />