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FOR OFFICE USE: Zi !�T�3 1Ar0� <br /> �• �APPLICATION FOR SANITATION PERMIT <br /> ... ...... _.._. . ---.--- Permit No. .A_L._g_�S. <br /> {Complete in Triplicate} <br /> This Permit Expires i Year,Ffom Date Issued pate Issued .7..)- <br /> Application is hereby made to.the Son Joaquin Local HealtKDistrict for a permit to construct a67, install the work herein _ <br /> described. This application is madii in compliance with'County Ordinance No, 5d9 and exi ting Rules and Regulations: <br /> i / n, Q <br /> JOB ADDRESS,/LOCAT N/X&4+-5Q,. TRACT ------------------------ - <br /> Owner's Name ........ -------- - Phone v - ---- -.- .e. <br /> Address City . . .--.----- ------- -------- <br /> Contractors Name ._.. '-:� -- �.-.��!'`Y✓ A..,,. .r..�.. ._License # 1.- 5��...... i'hane0- _ <br /> Installation will serve: Residence Apartment House Commercial -E]Trailer Court fl <br /> Motel © ether ^ " <br /> Number of living units: I Number of bedrooms -.3...._Garbage Grinder ........ . Lot Size ^--. �1------- . . <br /> l� tl <br /> _Water Suppl'y�'Publ'c-System and name-------------------------------------- �-•' ��^,.: .- -.-.... _Private <br /> Character of soil to a depth of 3 feet: Sand'El". Silt[) Cloy ❑ Peat❑ Saribl+ Lo&An ] Slay Loam F� <br /> Hardpan Adobe E] Fill Material ..:--.- —If yk type _ <br /> IPlot plan, showing!•siz-4 of lot, location of_systeni'"in relati n to wells, buildings, etc.11must_be,p.laced on reverse side.) <br /> NEW INSTALLATION: `_Wo septic tank <br /> �r seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT �[,l SEPTIC:TANK{]— S-ze....._ ........:----------._.... .__... Liquid Depth ....... <br /> tI <br /> Capacity ._.! Type _ Material-. --------I--------- No. Compartments ...................... <br /> � I <br /> Distance to nearest: Well .. . _ ----------i Foundation __.._..__. .. prop, Line ....................... <br /> LEACHING LINE 4[ ' No, of Lines .- Length of each line... .................. Total Length ...................._... <br /> ___. <br /> I dBox _... Type Filter Material _ :Depth Filter Material ............................................ <br /> Distance to nearest: Well _----------------_.__ Foundation + .. .-. .....-.-- Property Line ................ <br /> SEEPAGE PITl r <br /> [ 1 , Qepih -------------------- Diameter --.--�•-.•____-- Number ----..----__._._ .- .. Rock 'Filled Yes No <br /> I` I %v Water Table Depth ------ _. ............ .. . ............[Rock Size ............................ ,�}w 1 <br /> I Dis'ance to nearest: Well ........---------- ---------------------Foui`Sdaticn ------------------- Prop. Line -----............ <br /> \ . - `It'I <br /> ! REPAIR,/ADDITION (Prev, Sanitation Permit# ___•-.-_.__..-._.-_-.-____ ate--.-.--...-- ...V-1......................... s1 <br /> d Septic Tank (Specify Requirements) r I ...........................--­------------------------ <br /> Disposal <br /> ------Disposal Field i5pecify Requirements) ---------- . _ -............................. - <br /> +� <br /> ........... ..,.. ... ......... .....r.. •.. . ,.., n....__.:_...... <br /> 11i i <br /> IDraw existing and required addlticn on reverse side) <br /> hereby certify that I have prepared this application and that the work will be done in aeterdance with San Joaquin <br /> County Ordinances, State Laws, and kules and Regulations of the Sah. .foagyin Local Health District. Home owner or licen-� <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of The work for which thls"pernnit is issued, I shall not employ any person in such manner <br /> ` i l <br /> as to become subject to Workman's Compensation laws of California," 1 �� <br /> Signed --.... 11 -- - --- --... Owner <br /> r, r <br /> BY .... � .. ------ ----- -------------------------------------- Title �_ ". .. ..__..... . ----- <br /> I of r an owner) l <br /> .i <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED, BY .......................................... . DATE .... ........ ' <br /> BUILDING PFRMIT ISSUED .. ........ ....... .............. .. <br /> .DATE ......... .........X•... ............. ti <br /> ADDITIONALCOMMENTS .--_...------------------------- ............ ............... 1.� ..t .. ................---------------•--. �.__.._........... <br /> .......................................... ............... - -•--------------------------------- . ....... <br /> --..........,... .......................�.. ......................,........_._�_.r.:.vr:_....:...-.wr.,::._.._.----i .-• ..•..... ----r•----- - --_•....�_. ------ -- - - --- <br /> ^.......................... . .. <br /> Final Ins cc-tion b .....1:1 . . .-_---------- r-.'-�`:---------------- ------ --- - --------- -----Date _..f?..aY....)........ <br /> - —SAN JOAQUIN-1OCAL--HEALTH STRICT -` <br /> E. H. 9 1-'68 Rev. 5M C. <br />