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FOR OFFICE USE: <br /> APPLICATION FOV SANITATION PERMIT <br /> ------------------------------------------------ Permit No. <br /> ;lh (Complete irfViOlicafel , f�, -0 j,' <br /> Ikk--------------------------------------------------- <br /> D Issued <br /> $ kq1t , <br /> This Permit Expires Year From Date Issued <br /> Application is hereby'made to the San-Joaquin,Local Health,01strict for a permit to construct and install the work herein <br /> described. This application is made in compli,a6ce with Co'unty Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESSAOCATION 4(,P _,e"Iru---------�__ ---°---------------CENSUS TRACT ---------------------_-- <br /> -------------------- Phone._9 3/ . ....... <br /> Owner's Name A�Z, ------- ----------- <br /> .? - - Cit -�_ ------------- ------------------- <br /> Address /_'Ply _61 dl�­ ---------------- y <br /> F 1_ I- Phone -- ---------- <br /> Contractor's Name --------- - -- ----- ---------------------- - <br /> 7------------ <br /> Installation will serve.. Residencepart�mentHouotl Commercidr':E]Tra 0eir Court F] <br /> Motel F-1 Other -------------0---------------_--------- <br /> Number of living units:--- --- Number of bedrooms, .A5R---Garbage.Grinder------------- Lot Size -----4 ------------------------ <br /> Water Supply: Public System and name ------------------------------------------------------------------ ---------- ----------------- --------------Private>�' <br /> Character of soil to a depth of 3 feet: Sand 0 Slit t:j Clay E] Peat E] Sandy Loam -E] j Clay Loom. <br /> Hardpan E] Adobe 0 Fill Mat;r10 <br /> ----------- If yes, type --- ------------------- <br /> - <br /> '(Plot plan, showing size of lot, location of system in relation to wellsjjbuilclings, etc,. must lie placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feett <br /> PACKAGE TREATMEN-W SEPTIC TANK:[ Size-----------------r------ ------------- --------- Liquid Depth -----------------_------ <br /> Capacity -------------------- e I----------------- Material-------------------- No. Compartments ---------------------- <br /> TypI q <br /> Distance to nearest. Well ___!________--___------------------Foundation A---------------j---- Prop. Line --------------_------ <br /> I I -------------- ............ <br /> LEACHING LINE No. of Lines ------------------------ Length of each line---------------------------- Total Length J <br /> 'D' Box ------- ---- Type al I I ---------------- ...... <br /> Filter Material --------------------Depth Filter Material ---------------- <br /> Distance to nearest: Well ------! ------------ Foundation ------------- ---------- Property- Line; --____------------_--- <br /> SEEPAGE PIT Depth -------------------- Diameter-----------==r--Number--_----------------A--------- Rock Filled Yes ❑ No <br /> ❑ <br /> Water Table Depth <br /> -----------------------------------------Rock Size _.------------------------ ----- <br /> Distance to nearest: Well ---------------------_______._..---,--.-Foundation ------------------- Prop. Line _ -------_-_---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------------------- Date ---------------------------------- <br /> Septic Tank (Specify Requirements) --------------- ------------------------------4S------------ --------------- <br /> --- ------ <br /> ---------/------ <br /> Disposal Field (Specify Requirement <br /> ----------%_ ------------- ---------------------------- <br /> i <br /> ---------------*--------- <br /> ' 7 - <br /> -------------------------------------------------------------------------- - ___ - " 's I - ------/-------- -------- <br /> .......g------------- : <br /> i�lte. . ------------1\ <br /> ---- -- ------------------ <br /> ad ition on reverse side) <br /> (6r -�exis aired <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinankces,-State Laws,- and-Rules and Regulations of'the San Joaquin-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 this permit is issued, I shall not employ any person in such manner <br /> as to bee e su ject toork s Compens7at* n laws of California." <br /> Signed ------ ----'A -------- --- ------------------ Owner <br /> By <br /> W_� Title -------------------- --------------------------------------------------- <br /> ---------------------- .. .... <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> !I A <br /> TV'r- MV U-L-C <br /> APPLICATION' ACCEPTED BY -----------------,----------------------------------------------------------------------- -- ------- DATE -------- ------------------- <br /> BUILDINGPERMIT ISSUED -----------------------------------------------------------------------------------------------------------DATE ------------------------------------------- <br /> ADDITIONAL COMMENTS --------------------P-v-- - -------------•--------- <br /> W2 <br /> ------------I--------- <br /> - --- -------------- --------w-----V--------------------------------- -------------------------------------------- <br /> ------------------------------- -- -----------1_144________ ----- -2 ------------------------------------------------------------ ---------------------------------------- <br /> - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------ <br /> - --------- <br /> - x- ---- <br /> & I . <br /> jl -- ---- ------ <br /> - ----- ----- -------------------------------------------------- ----- -e- 121 <br /> i Final Inspection by; ---------------------------------------W ?,!�--- ------------------------------------- Dat --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />