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FOR OFFICE USE: APPLICATION FOR] SANITATION PERMIT <br /> 4 Permit No. <br /> - - <br /> ----------------------------------I.........;----------- (Complete In Triplicate) <br /> --------------------------------------------------------- Date Issued <br /> I ��A_1 01 <br /> This Permit Expires <br /> .......... Your From Date Issued' <br /> and install t6-work-herein <br /> Application is hereby:made to the San.16ciquin Local J-1salth District fora permit to construct 0 <br /> '�rato o. 549 and existing Rules and Reg6lotions: <br /> described.� This application is made 1A,compliance with C�6nty Ordinance N <br /> ............ .. ... ---- :-------- ............ <br /> OCATION .... ... .. ...... .. ...... <br /> CENSUS TRACT JOB ADDRESS/L <br /> OwnersName . ..... ...... ----••-.- hon --------------------------------------- <br /> Address ................ . ------------------------------------------I........ <br /> iii C, <br /> 'A nsp .......... <br /> Contractor's Name _ . ... ......... ---- Lice Phone <br /> I C, <br /> Installation will serve: ,Residence Apartment Houeo- Commercial I railer dou,rt <br /> AWI: <br /> Motel E]Other............. ....... ........ <br /> Number of living units:.._ —liumber of bedrooms ..7r=.Garbage GrinderLot Size -------------------- - ------ <br /> Water Supply: Public System and.name ----------------------------:...... -•-----'---------------- Pri\fqte,, <br /> .................. ...... <br /> CharacterSilt{:] Gla Sandy Loam <br /> ofciltoa depth of 3foet:` Sand y <br /> F -------- If yes, ......... <br /> Hardpan Adobe <br /> is - I . . . . <br /> _,,(,IPlot plan, showing size of lot, location of system in relation to wells, buildings, -ete., musf-be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or se u ic seVe�is available within 200 f6et) -41, <br /> seep pit permitted 161' / <br /> Liquid D ---------- <br /> ijul Depth GE TREATMENT SEPTIC TANK;; SizeA�, -,U <br /> J <br /> Capacity U-4i , No. 'Compartments ............... <br /> ----------- %r <br /> 4 , <br /> Aistance to neares t Well .........Ittv'i a' .......-..,.'.,Foundation' ---------- Prop. Line ...... I...... <br /> 1�ttypep------ <br /> No. of nes ....... Total Length ............................. <br /> L ........ Length of ea��h line:...-. ..... .". 1% <br /> Ma' rial --------------------- ------------- <br /> r '137. Box., Type Filter Material De th Filter to <br /> 'C <br /> Distance''tni rest. Well ......V.0-a-1------ F'oundat.i -A-02-------------- Property Line <br /> _7N <br /> —SEEPAGE PIT, IDepth . flPt------------- Diameter ---------- <br /> ---- Rock Filled Yes ff No 0 <br /> itl <br /> Water Table Depth ..............pp ... <br /> ........ .-•----------..Rock Six's ---/J/---• <br /> --------------------- <br /> DistaDi <br /> ince..tc?lp ..............-"`Foundation,-_--_- Prop. Line .... ................. <br /> ..............------ <br /> ,_RfiPAIR7ADDITI0N-(P(eFV-SFn_it',,i6n Pdrmit ------------------------ <br /> {Specify Requirements) ---------------- ........................ ----------------------- ........................................................... .... <br /> ,Disposal Field (Splecify Requirements) .----_-•...............•-•-----I"?...... ..... <br /> --- -- -n .... <br /> ----------------------------............. <br /> ---------- - . .. .............. <br /> -------------------- ----------------------------------------------------_------ <br /> ............ ----------------------------- i <br /> -------------------- ---------­­r-l'------1­----------. -- ----------- ......... <br /> - ------- - -- <br /> (Draw required side) <br /> I hereby codify that have prIcired this application.and that the 'work will he done-in accordance with Son Joaquin <br /> County Ordi"nces, State Laws, and Rules and Regulations of the San Joaquin Local- Health District. Hortie, owner or licen- <br /> sed agents signature,certifies the following: <br /> "I certify that iii,the performance of the work for.which this permit Is issued, I shall not omploy any person in such manner <br /> as to become subject to Workman's C inensoltanlaws of California." <br /> \ - , <br /> Signed ------------- .... ..... ..... ............. Owner <br /> .........I Title ------- <br /> ............ . ...... ---_--------------------- <br /> By--- ..................... <br /> (if other than owner) <br /> FOR 9EPA1tTMkNrUSC ONLY <br /> APPLICATION ACCEPTED-BY ------- ........................•------------------- ------- DATE --f-----•------------ <br /> i <br /> -f----------------- <br /> BUILDING PERMIT'ISSUED...................•--•-----------------••--•-----..----. -------- -------------------------------------DATE .................... ---­-------------__ <br /> ADDITIONALCOMMENTS:�I ......A.....................................11............--1..................................................... --------------------------- <br /> ........................ ..... -------------- ------- ----------------------------------------------------------------------------- <br /> -------------- ------------------------------------------- <br /> ------------------------------------- ----- .................._....---•--------------------------------------------- .............. ............. <br /> I :. -1111-------------�e------------------------------------------- <br /> ----- ------------- ---------- <br /> Final Inspection by.. ti ........................................................................D -;/-47 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F. . 1-'68 Rev. SM <br />