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APPLICATION FOR SANITATION PERMIT <br /> '41 1-1�.:.........................1' ..J ..... (I;ompletein Triplicate) Permit No. . 6�. <br /> ................................................. . <br /> This Permit Expires 1 Year From Daft Issued Date Issued ..S :. :. r <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the work hweln <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION 4. �/_.---.- ... .. -...._..--.....- <br /> ............amus TRACT ............. ............ <br /> tl <br /> Owner's Name ...l�.A'r'1...._. .... .. ',!?rs................................. <br /> .........I............. ........................Phone .L�-�.1.-..�..� .......... <br /> Address ...... I.O.. _ lid...... .• ?;"......--••.........•.............•........City ..e.............--- <br /> Contractor's Name ....../JV'!�'µ........................................................ ....jki nse * ........................ Phone ............................... <br /> Installation will serves Residence❑Apartment House Corr'tf9W.VTraller Court ❑ <br /> Motel p Other....................................... <br /> Number of living units:............ Number of bedrooms -----------Garbage Grinder ............ Lot Size AIRA........................... <br /> WaterSupply: Public System and name ..................................----------------- ...........-......._.................................Private' <br /> Character of soil to a depth of 3 feet: Sand E3 Silt❑ pay Ib Peat Q Sandy Loam a Clay Loam ❑ <br /> Hardpan❑ Adobe❑ Fill Material ............ If yes,type ............... ............ <br /> Piot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATION: (No septk tank or seepage pit permitted If public sewer Is available within 200 feet,))/ <br /> PACKAGE TREATMENT I ] SEPTIC TANK aj Size.3.+6?A-r .......... Liquid Depth .7.. ------------ <br /> Capacity .APP.......... Type .&-*.. Material... ....... No. Compartments ..air................ <br /> Distance to nearest: Well ....AQ_,....I.... ...........Foundation ...�..._......_.... Prop. Line .......k. <br /> LEACHiNG LINE J4 No. of lines J................... Length of each line....a.P...................... Total Length .. 0.�.............:� <br /> 'D' sox .YV.9..... Type Filter Material .....Depth Filter Material ../9.'.. ..3: <br /> Distance to nearest. Well , .......... Foundation .4.7' . Property Line S-A............... <br /> SEEPAGE PIT ( g Depth .................... Diameter ................ Number ............................ Rock Filled Yet NoE <br /> Water Table Defith ......................._.......................Rock Size.........--•-••---•......_I...... .� <br /> Distance to nearest, Well ........................................Foundation --- ................ Prop. Line ......... <br /> _....... <br /> . <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date .......-----_--------------._-I <br /> Septic Tank (Specify Requirements) .................•--..................... ...... --••--••--•----•-•---•--........---•---•----•=_•--..--•-•---••-......•.......... . <br /> Disposal Field (Specify Requirements) ................................... <br /> ....: <br /> ............................................... .....................................................................----•-•--•-...------•-•--••-•----••-•------.................-•-.. <br /> ... J�l <br /> .................................................. ............................................. ............................................................................................ <br /> .i <br /> (Draw existing and required addition on reverse side) <br /> i hereby certify that i have prepared this application and that the work will be done In accordance with Sar Joaquin <br /> County Ordinances, Slate Laws, and Rules and Regulations of the Son Joaquin Local health District. Home *wow or licen. <br /> sed agents signature certifies 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 bec a subje to o an's Compensation laws of California." <br /> agnea! . . _ .c .�. _ �t..�z .,✓ '-----------. -- Owner <br /> By ......................... . title <br /> . ... .............. .......... .......................... ........................................................................ <br /> (If other than o nerl i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY . . <br /> .... ()ATE . -��-1 .••.•: .:••.•:••..•:': <br /> ............................................................. <br /> BUILDING PERMIT ISSUED ............:..DATE=.........................:................. a <br /> ADDITIONAL COMMENTS ...... ............................................................................ <br /> .. . .. .........................................-- -- ..._......... <br /> . ..... ---•••........................... <br /> ---- 1- . ......... ... .......... ... ...._.........,...... <br /> Final Inspection by; ... ,�-.� . ------------------------------------Date . ..`�..7. ... .. .......... <br /> Di 13 2h 1-68 11ov. 5N SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />