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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT V . <br /> 1-?'--=----- -------- Permit 3 No. . �-49.3 <br /> _7..----------•--- <br /> 'Complete in Triplicate) <br /> --------•_•-------------•_-_-___------------------- This Permit Expires 1 Year From bate Issued <br /> Date Issued ._9��:_7 Y, <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application is ma /t [F�ompliance with/County Ordinance No. 549 and-existing Rules and Regulations: <br /> -'-„ :CENSUS-TRAC1 .,_ <br /> JOB Aiai�RESS/LCOCATIONto :y -- -" - :t - <br /> --------- _- <br /> g <br /> Owner's Name _...__.. S ----.Phone._.__ _ s:� •-��- �, <br /> So � , <br /> Address --`- r ----------------------------------- _..... City ,_ t------ ....--•--..._... ----'•--- <br /> Contractor's Name ---:- u�� ------ ------------ --------------License # - �> � _�__ Phone fa�..✓ <br /> ----- . <br /> Installation will serve: �-. Residence Q0 Apartment House-(] Commercial O3 railer Court ;❑ <br /> I Motel ❑Other -------------------------------- ----------- <br /> Number of living units::_..-------- <br /> Number of bedrooms _..Garbage Grinder ._:" ... Lot Size -- -lJ...'.1._­-----­------------­--- <br /> Water Supply: Public System and name'------------------------------------------------------•-------------------------------------•--•---•--------"Private ❑ <br /> Character of soil to a d-ep;•h of 3 feet: Sand'❑ Silt❑ Clay ❑ Peat❑ Sandy Loamy Clay Loam X <br /> �. Hardpan I] Adobe ❑ Fill Material ---------­- If yes, type ____________________________ <br /> (Plotlplan,Ishowing-)size of'lot, location of system in relation to wells, buildings, etc.• must be placed on reverse side.) <br /> NEIN INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT r( ] SEPTIC TANK'] = Size_ Liquid Depth --_40F.l_........... <br /> "• %' Capacity ./.a1L1!J-_-.- Type - Material .---- No. Compartments <br /> ` Distance to nearest: Well -------- ---------------Foundation ___-0.e)....... Prop. Line L....... ____-_ <br /> ` �j � C <br /> LEACHING LINE ( r No. of Lines +........��__.._____._ Length of each line______.fs ____.__._.. Total Length _._�__�1.�_.�.. <br /> ri ,i <br /> 'D' Box _..'__-:___ Type Filter Material __-- �:........Depth Filter Material ___. __..._.__ �....:..._ S <br /> l <br /> 1 Distance to nearest: Well.,_.,,l .f _ ..,,.;-Foundation --. <br /> �� <_.!' Property Line .._�!'.-•.--•:_-•-- <br /> SEEPAGE PIT Depth o4_cd.._. Diameter s-13-`z..... Number ...._...__ Rock Filled Yes No <br /> p - ttom- i� <br /> i Water Table'Depth .............. r --•--- -------Rock Size --- g----------------------- <br /> Distance to nearest:Well ... ! lJ ................Foundation --sem-- ---�_._- Prop. Line ...la.• <br /> REPAIR/ADDITION(Prev. Sanitation Permi## ,__________ _______________________________ Date ________-_---____:______-_------__1 <br /> Septic Tank (Specify Requirements) ........ Vic_ -C1 --`---------- ------------------•- ---------------------.-------------------------I <br /> Disposal Field (Specify Requirements) ....16.. -- -- ................ ---------------------------•------------ <br /> 14-7 <br /> ------------ <br /> i �y - <br /> ------------------------------ ------------------------------------ .................-- -- ------------=----------- -------------------------------------------------- --------------- <br /> (Draw existing and required addition on reveFse side)) <br /> I hereby certify that 1 have prepared this application and that the work w4111• be clone inaccor`dartice`with Sarr Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. dome owner 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 become subject to Workman's Compensation laws of California." <br /> Signed ---- ----- --- ----- -- ................................. ...... Owner <br /> - _ ••---- .... ........ . ............. <br /> BY ---- --------- <br /> Title ...... <br /> (If other than owner) <br /> pfo PARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _.. JV --- ----••--••••---------------------•-•---•-. DATE . <br /> BUILDING..P.ERMIT JSSU.ED.. --- ------- :' _ = -------:--------_-- _ - ----- DATE.-.. .-� :, ::_ _ <br /> ADDITIONAL COMMENTS ---- ---•.�I------ -- -----,• - ------- -- ------------- --- ------ ------- <br /> 67-q <br /> - <br /> ,..-- k'----- ------r-- - -�-•------- <br /> .........................•---------- ---- ------ -... - - ---------------------------•------------ -•----•----- -----------• --•--•----------------- .... ---- <br /> FinalInspection by; ...... ------- --/ ------------------------------- ---------------------------------------.Date ... <br /> JOAQUIN LOCAL HEALTH DISTRICT <br />