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R <br /> FOR OFFICE USE: I APPLICATION FOR SANITATION PERMIT <br /> Permit No. .T�l-/�- y. <br /> (Complete in Triplicate) <br /> ... <br /> Dote Issued /.. ........ <br /> This Pormit Expiros 1 Yea:F:cm Dote Issued <br /> ereby <br /> the <br /> al <br /> alth <br /> ec' is <br /> o` iel•'�� <br /> District <br /> G <br /> : install rein <br /> described. This application made in compliccewihCoutyOrdinana No. 549 and existing Rules and Regulations <br /> r-*&..^-{�.a..CENSUS TRACT ......................... <br /> JOB ADDRESS/LOCATIONy ... .... ....... � <br /> . . : ........ . ........................... <br /> Owner's Nome I1Phone ......... <br /> c� <br /> ; <br /> Address ' 77 �f:.. t.:r!..... City .............:....'-'".......P„.................................._. <br /> �'{ .... one <br /> .....-10 <br /> ...................... <br /> Contractor's Name ....----• . �*<.t........ �---�.;....•.:^::•::.lCa....... ....:.....License# ./.. ..�.�-... <br /> Installation will serve: Residence 2-1�-partment Housefl Commercial CDTroller Court 0 y <br /> Motel 171 Other " '' <br /> sic J-...... <br /> Number of living units:.......).... Number of bedrooms .... :-.Garbage Grinder ............ Lot Size .............................. ... . <br /> .........................Private A <br /> Water Supply: Public System and name ........................... ............................ �j <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy loam ET"-Clay Loom ❑ <br /> Hardpan❑ Adobe 0 Fill Material ............If yes,type............................ �\ <br /> ..� of lot location of system .n relates ion to wells, buildings, etc. must be placed on re arse side. <br /> (Plot plan, showing size ) <br /> NEW INSTALLATION: !No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( j SEPTIC TANK J Size................................................ Liquid Depth .......................... <br /> Material...................... No. Compartments ...................... <br /> Opacity .................... Type .................... , <br /> Di.ronce to nearest: Well ....................................Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE No. of I,in.+s ..................... g <br /> .. Length of each line............................ Total length <br /> [ J <br /> Depth Filtr r Material <br /> 'D' Box . .......... Typr, Filter Material .. p No..:.. <br /> Distance to nearest: 'Nell ........................ Foundatior: Property Line ...•................. ................ . .... <br /> Depth Diameter N��mber ............................ Rock Filled Yes ❑ N <br /> SEEPAGE PIT [ J P • • •"••-••"•"••"" <br /> RockSize ................................ <br /> Water Table Depth .................................. \i1 <br /> , ............ `V <br /> Distance to nearest: Well ........................................Foundation ......................... <br /> ................... Prop. Line ...................... <br /> .......................... Date ..................................J <br /> REPAiQ,ADDITION(Prev. Sanitation Permiai <br /> # ••• . <br /> ...-1��3�t.N ..._............................... <br /> .. <br /> Septic <br /> .. ............................................... <br /> Septic Tank (Specify Requirements) ..... L "' "'"'.Q�.-elf �{ <br /> Disposal Fiald (Specify Requirements) §.....-y Q <br /> ................................................... .......... . <br /> . .............................. <br /> .................................... ....... <br /> .. . .• (prow existing and required addition on reverse s d e <br /> red cation and <br /> hat the work w!!l be <br /> ne in acrorclance <br /> h Son Joaquin <br /> I hunty Ordin'fy amms,tI have S!to Laws, ond Rules and Regulations tof the Sar Joaquin LocaloHealth District. Hometo ner er I can. <br /> Co y <br /> sed agents signature certifies the following: <br /> "1 ce.tify that in the performance of the work for which this Permit is issued, 1 shall not employ any person in such rnanner <br /> as to become subject to Workman's Compensation laws of California." <br /> ................ <br /> Owner <br /> Signed ...._........................... �..........'....../:. 1 I <br /> .. .............. i4=:�4•:a:....(::..... .�,:..0 y:1...c...... Title ....�. 't� C... .G.........:......... <br /> By (if other than owner) I <br /> FOR DEPARTMENT USE ONLY <br /> � DATE .....�L. ..�.�'..7 y......... <br /> I <br /> APPLICATION ACCEPTED BY................A—ii ........ .................................................................. DATE .......................................... <br /> BUILDING PERMIT ISSUED .......................................................................................................... <br /> ADDITIONALCOMMENTS .......................................................................................................... ......................................... . <br /> ................................ •........ ................................................. ..........................Date ..../.L.. .1 .�. ............... <br /> f <br /> ..inal...........tion.... . ............................. .. ........................ <br /> Final Inspection by: ................... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT C <br /> 7/72 3 K <br /> E. H.13 24 1.-68 Rev. 5M <br />