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rtisrc vrrr� egg, <br /> APPLICATION ICOR SANITATION PERMIT � <br /> ......................................................... Permit No. .. <br /> (Complete in Triplicate) ; <br /> ..................... ............. '1hlr Permit Expires ! Year From DateIssued m Date Issued .11:7X'' f <br /> zL <br /> Application is hereby made to the San Joaquin Local Health District forconstruct and permit to constrand Install the work herein <br /> aieaaibed. This application Is made In compliance with County Ordiriance,No. 549 ar+d existing Rules and Regulations, <br /> 1 JOB ADDRESS/LOCATION- �� 1 :, ; .: T ` ..CENSUS TRACT <br /> Owner's Name ..... ..1. :..... ............ . .Phone <br /> Address . .- ' r � .�. ........................................City .... :�/ /G'r!j D2+ ...,,�. , <br /> Contractor's Name ._ •...................•--.........-----...License VKVIZ. .�1 .........7. . <br /> Installation will serve: ICIL�partrnent Houseo Commercial❑Traller Court ❑ <br /> 1 � <br /> Motel❑Other. <br /> ,.,:.Number of Iiving;wnifa:----------.- Number of bedrooms ....,....Garbage Grinder ............ Lot Size -------------------------------------------- <br /> Water Supply: Public System and name --------------------------------—--- ......._....... <br /> ...........................................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ day Lao m E3 <br /> �? 4Y Hardpan❑ Adobe❑ Fill Material ....__...... If yes,type <br /> (Plot plan, showing size of lot, location of system In relation►-tokwells, buildings, etc. fust,be placed on reverse side.) <br /> NEW INSTALLA1tONe (No septic tank or seepage ptt'pe„ymitted if.public-s wer-is avaUo—bfe wit�rin 200 feet,} <br /> PACKAGE TREATMENT ( ] SEPTIC TANK JSize..... :_......... ......................... Liquid Depth .......................... <br /> E} l Capacity �/�— �� pe ..Material. .................. No. Compartments ..` _-..... <br /> I Distance to nearest: We 1� ...� �.�._........._ 4:Faundation .-� ..'..---.-.-. Prop. Line .......................� <br /> -----•- <br /> LEACHING LINE ' No. of lines .-- Leitgth.of ach`i e`.' -•-•--•--.•.-.... Tota) Length ► . .................p <br /> [ ) ......-------- <br /> ,�'D' Box .- ----=Type-Filter Material .. .�bi <br /> ..Depth F lte Mat ia`I �.... <br /> C� _ ..-- ----•......._.... <br /> i . . <br /> I Distance to nearest: Well .. tion Property Line i <br /> SEI:P,G E PIT [ -Depth .................... Diameter ....:........... Number ............................ Rock Filled Yes ❑ No <br /> ^Water Table Depth ....................... ...Rack Size <br /> f <br /> { i <br /> fef <br /> Distance to nearest: Well ........................... .........Foundation .................... Prop. line ......................? � <br /> REPAIR/ADDITION Wiev. Sanitation Permit# ••.«---------------------------------------- Date -.............:................... <br /> 1 <br /> Septic Tank lSpeclfy Requirementsl .. <br /> DisposalField ISpecify Requirements) ........ .......................................................................................................:............. <br /> .:..... <br /> r € - <br /> ............................. . ..._...................... ........... .................... <br /> ...... • <br /> ............---: ...._..........•....._............ ......................_.................«.... ..,.. <br /> F _ (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 San Joaquin <br /> County Ordinances; State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or Ilcm <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 /> � ct:to rkman's ompensatlon laws of California." <br /> as sub to become ' � <br /> je.; . <br /> ..... Owner <br /> By;.... ..:.......................•---.. ....._.....__.. 7itte <br /> N(#f other than owner) l <br /> FOR DEPARTMENT USE ONLl( <br /> ...................... <br /> APPLICATION ACCEPTED BY ., . -.. DATE ... .� ..- <br /> BUILDING PERMIT ISSUED .......... DATE ...--... <br /> . ..... ....................................................................... ... ........---................... <br /> ADDITIONALCOMMENTS ...............................................................................................-. .............--................I........................... <br /> ... ....... <br /> .......... .......•--•.......-.--.............. <br /> .......... <br /> .............. <br /> ..---..... .r.................. <br /> .................... <br /> ...... <br /> .......... <br /> ......... <br /> .............. <br /> .... <br /> ........... <br /> ............... <br /> ................ <br /> .................................... <br /> .................................. <br /> ....---.....-.. ...-....... -- ...-- . . ..... . .. <br /> � ... ... .. ........ 3 <br /> Final inspection by- ------- -- ••- - - - -- --- -- . .................•-•---....-........Date . .,... ....... .-... j <br /> EH 13 24 1-68 V e SAN JOAQUIN LOCAL HEALTH DISTRICT 5/7h 3M <br /> I <br />