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Fo12 OFFICE u5>;: ° APPLICATION FOR SANITATION PERMIT <br /> Permit No: 7- <br /> ' e 6 Y <br /> • --_- ��•- <br /> -fa_a <br /> --- ----'3 ��- --P-� " --- �- � (Complete in Triplicate) }. <br /> 1 "' <br /> -- --------=--�------ �- ----�-�-�' ��,y Date Issued __..---------�-�• <br /> --- ------------------ - <br /> �j This Permit Expires 1 Year From Date Issued _ <br /> Applical"iis�lierebyLocal Health District for permit to construct and�made to€tre;San Joaquin <br /> i. tallthe work herein <br /> de`.in-com once with County Ordinance No. 549 and existing Rules and Regulations: <br /> descrobe�. This 'applicationCATION `s ma !� CENSUS TRACT ---�r6--------------- <br /> JOB ADDRESSAO Phone <br /> Owner's Name <br /> Cit <br /> Address . - <br /> a k Qil_ � Y ; <br /> # <br /> -------License <br /> /p��rll ---- Phoneck6-5F z <br /> Contractor's Name --- ------ ------ -- -- <br /> IF'+,...'- • i <br /> Installation will serve `" i4; ResidencApartment Hou '❑ Commercial ❑Trailei Court ,❑ <br /> i Motel❑Other ; <br /> / k l <br /> �__-_Garbage Grinder -__-___-.__ Lot Size -.___ .__ � <br /> Number of living uni sr._-e I- ,`hlum,ber sof bedrooms Private)4 <br /> 4�•4, 1 • <br /> Water Supply: Publ"ic.System and name 'f' +"------------------- ------------° . x - <br /> # `P,edt ❑ Sandy Loam ❑ Clay Loam ❑ <br /> Character of soil to a depth of 3 feet: Sand's Silt❑ Clay ❑ <br /> . . _._._= -. ... .;�-NII_M6teeia`l -'.._Tf"Y'e"s;fype _ "'----- <br /> ._ hlardpan ❑ AdobeN. <br /> !' t Ian showing size of lot, location�of,system in relation to wells, builclings, etc. must be placed an reverse side.] <br /> (P o p g <br /> 11-1 0" <br /> p seepage ge pit permitted if public sewer is avalliible�wln 200 feet,) �• <br /> =Li Liquid De tO------------------ <br /> Size -+ <br /> NEW INSTALLATION: (No septic tank or <br /> SEPTIC TANK;[ ----------------------- ---------- 9 p , <br /> PACKAGE TREATMENT [ ] � - i,k' i Q <br /> - *-�V No. Compartments <br /> Material------------- --- <br /> Capacity ----------------------- ype ;..M,... _ ,. <br /> Distance to nearest: Welly -------------------- Foundation -_-°;------ Prop. Line -------------- <br /> n #h of each line----------------------- Total Length ------ ---- <br /> LEACHING LINE No. of Li <br /> •- - <br /> [ ] nes -- ----------- Le <br /> --------- \ 9 I <br /> Depth Filter Anterial -------------------- --------- - ------•---- <br /> D' Box -------------- <br /> ---- ------ <br /> kWType Filter Materia'I _-_--------------- -t <br /> # Foundation ------------ ------- Propeirty-Linl ------------------ ti <br /> Distance to nearest: Well _ ` <br /> Depth { Diameter -- Number - ___ -- Rock Filled Yes ❑ Nit �❑� <br /> SEEPAGE PIT L 1 p <br /> 1 ------------------Rock Size ------- -------------------- -- <br /> G Water Table Depth -------------- --------------- � <br /> - _!'Y_Foundation j---------- ---- Prop. Line -----------------•---- ' <br /> �. �- °- <br /> Distance to nearest: Well _________________------ <br /> ------ --------- Date ----------------�--------"--------I <br /> REPAIR/ADDITION{Prev. Son'tdtionlerrYlit S# ------------------------� } <br /> _ _ ______-__f- <br /> 7 _ <br /> Septic Tank (Specify Requirements) ----------------- ---------- <br /> Disposal Field (Specify Requirements] -------- ------ <br /> ` <br /> ------ ------------------------ --------------------- e - <br /> ------------------------------- -------- <br /> l (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 <br /> Health DistrctnHomewith <br /> owner or I cenn <br /> County Ordinances, State Laws, and Rules a� nd Regulations of the San Joaquin Local t <br /> sed agents signature certifies the following: <br /> 111 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 /> f Signed fnsL Owner <br /> - ---- — . e_-.T <br /> ------ ------- -------- <br /> (1f o r than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ---- - Ems- - <br /> Q 7��� DATE DATE _. J <br /> ---------------- <br /> BUILDINGPERMIT ISSUED ------- ------------------------ ------------- ---------------------- ------ ----------------------------------- <br /> ADDITIONA COMM •- = f� -i----------------------------------------------- <br /> ---------------------------------------------------------------------------------------------------------------------- <br /> �c= 3- - -' -------- .3------XK 5---------------- ------------ --------------- <br /> ------ ----------------------- <br /> ------ ---- -------------------------- ----------- <br /> --- -- ----------------- <br /> ------- -- � <br /> --------------------- --------- - - ---- <br /> SAN <br /> ate ---- a-'---- <br /> Final Inspection by: --------------------------------------------- - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 ' 1-'68 Rev. 5M <br />