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DATE ..... • <br /> DATE) <br />r- <br />APPLICATION ACCEPTED BY <br />BUILDING PERMIT ISSUED <br />ADDITIONAL COMMENTS <br />Perrnit No. -// <br />Date iisuel 7t <br />APPLICATION FOR SANITATION PERMIT <br />Kotinplete in Triplicate, <br />This Ponnit Expires 1 Year From Date Issued <br />Application Is hereby made to the San Joaquin Local Health District for a permit to construil and Install the work herein <br />described. This application is made In compliance with County Ordinance No. 549 and existing Rules and Regulations' <br />JOB ADDRESSAOCATIQII /X3-Q2.-9 a./ G.ran 7i-.46$,Z CENSUS TRACT <br />Owner's Name Ked L /'. Phone ge.6 <br />Address City <br />Contractor's Name 6 et/Per% License # Phone <br />installation Will lidiNgh <br /> Residence jApartment House 0 Commercial 0Traller Court CI <br />Motel 0 Other <br />Number of living units' Number of bedrooms Garbage Gdnder Lot Size <br />Water Supply: Public System and name Private <br />Character of soil to a depth of 3 feet: Sandi] Silt 0 Clay 0 Peat 0 Sandy Loam 0 Clay Loom 0 <br />Hardpan Adobe (3 Fill Material If ye*, typo ...... ....... <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) , <br />NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet) <br />PACKAGE TREATMENT ( 3 SEPTIC TANK (3 Size liquid Depth IT <br />Capacity Type Material No. Compartments \A <br />Distance to nearest: Well Foundation Prop. Unto ....- .... ...........ii <br />1.EACHING LINE 13 No. of Lines Length of each line Total Length <br />'D' Box Type Filter Material Depth Filter Material E <br />Distance to nearest! Well Foundation Property Line <br />Depth Diameter Number Rock Fined Yes 0 No 0 <br />Water Table Depth Rock Size <br />istance to nearest' Well Foundation Prop Line .. .........., <br />Sanitation Permit # Dote ) <br /> <br />_ <br />• <br />SEEPAGE PIT ( <br />Septic ank (Specify Requirements) <br />Disposal Field (Specify Requir ents) <br />iddi <br />iic6.ey „Lai <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 Sao Joaqui <br />County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Haan* owner or llct <br />sed agents signature certifies the following: <br />"I certify that in performance of the work for which this permit is issued, I shall not employ any person in such manner <br />as to beco ablest Work • L..Compensa1Ion laws of California." <br />S:gned <br />By_ <br />Owner <br />Yitie <br />f • t a owner) <br />FOR DEPARTMENT USE ONLY <br /> <br /> Date <br /> <br />Final inspection by: <br />a1 13 2h 1-68 itav <br /> <br />SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />