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FOR OFFICE USE: APPLICATION Y-OR- -SANITATION PERMIT <br /> Permit No. <br /> ......... <br /> . <br /> 'Complete in Triplicate) <br /> ------------------------------------i----- <br /> Date Issued ._a. . <br /> This Permit Expires 1 Year From Date Issued <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 made in compliance with County Ordinance No. 49 and existing Rule's and Regulations: <br /> JOB ADDRESS/LOCATION ._ C4.3 D._._ - Q f`-. - -/ � -• -Q-`=1-- - ENSUS TRACT -------------------------- <br /> Owner's Namer1� � ... - __Phone <br /> Address' . . .'... City / ry---- _ -----------------------------------••----- <br /> Contractor's Name -- � •:----/�� P i, ------------------------License f �� .Phone .`1f--�. <br /> Installation will serve: Residencejk<Partment House❑ Commercial:❑Trailer Court :❑ <br /> Motel ❑ Other ------------ --- -- --------------- <br /> Number of living units:.`'_-._. Number of.bedrooms.-_ ___ <br /> . Garbage Grinder, /P.. Lot Size .. Pte%.. - -'------ <br /> Cl . <br /> Water Supply: Public System and name ---- L ---•-------..... -....:----•-----=------ -- ----- ---------------------------- -PrivateX <br /> Character of soil to a depth of 3 feet: and.'❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> ' a Hardpan Adobe [7 .,Fill Material ----- ----- If yes, type ............................ <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: <br /> PACKAGE ION: { o'Septic <br /> t k or seepage pit�'permitf63_7 public;sewer"is available within 200 feet,) <br /> TANK � h Size__ __X%x,,6'�______ ________ Liquid Depth <br /> ( ] de <br /> Capacity yp ��ti ....iMaterial, �l :_.__ No. Compo tments __. --_:._...... , <br /> ! " —� <br /> istance to nearest:' Wel _e��----------..Foundation ._, - -___________ Prop Line, .._:.._.._. <br /> Len � `__ Total Len <br /> LEACHING LINE No. of lines _____ ________________ Length of'each line.___. __ �• gt / .�-______-- <br /> D' Box GC'`�r Type Filter Ntaterial`�r7� Depth Filter Materia) /!� __.__.__ _____________ <br /> Distance to nearest: Well ._ ..__ -. .. � Foundation�'':.�Q.�-._____._. Propeirty e .�>�''-�___. <br /> ------ <br /> �/}� i <br /> ________________Rock,Filled, Yes No I❑ <br /> SEEPAGE PIT Depth cr�.�� DiameterXju��- Number ---._ ____-. <br /> ..yy / /« <br /> Water Table Depth - -•---f•��------------------------------Rock Size ---�---"��------ ----- <br /> JI. <br /> •--- <br /> ! ! <br /> i Distance to nearest: Well --�1 '___________________Foundation .' a-________: Prop Line .._._...__.. , <br /> I} f t <br /> Sept Tank.(Spec(Prev. Sanitation Permit�# ----;-:........... ................... .... Date -- --------------•---AI <br /> •..} <br /> REPAIR/ADDITION r ------------------------- <br /> ------------ <br /> pADD1T ON fyRequirements) - --------------- <br /> •---------------------- <br /> Disp sal Field '(Specify Requirements) --.--__----__ ---------------------•----------- <br /> _. r - -------•--•-------- --••-------------------------- , .,,,� -.w, --- �.,; <br /> i ..._ .... - - s --AiW---- ------- _ - ------------------- <br /> - = (Draw existing and required addition o%reverse side) - <br /> // ��,, i# .� <br /> E he cern the t h 4 prepared this application and thlit the work will b� done i e?�eord ne��v�►ith man J+Scsquin <br /> County Ordinances tate Laws, and Rules and Regulations ot'the San Joaquin McIal Health District. Home cium 'or licen- <br /> sed agents signature certifies the following: , <br /> "I certify that in the peAllimance of the work for which this permit is issued, I shall not employ any person In such manner <br /> as to become sub)ect to Workman's Compensation laws of California." <br /> Signed ................ . •-- ------- --- . ------- -- -- Ow er 1 <br /> By ------------------- ------ - - - ...------ _.� :- .'itle : -i �� � - <br /> ¢ (If er thaw o"ner.• <br /> l FO EPARTMENT USE ONLY <br /> t ..... ............. <br /> •-_-_--� - � <br /> BUILDING PERMIT ISSUED ...... T <br /> ...............•..... =----_... ..__--•- � 'bAT,E _ ... <br /> I ADDITIONAL COIJ.tENTS --------------------------------- .......................---- -_-- ----------------..-. --- ..--•------ ............... •• --- <br /> --------------------------- X+s------ -- _ _ -------------------------------------- <br /> 4. <br /> `�' <br /> _..... - - --- - ---- <br /> Final Inspection bY: ..._.._....' { Date �� ..... <br /> SANZAQU1N LOCAL HEALTH DISTRICT <br /> F H 9 1-'AR RaV 5M. ► <br />