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, ;573,07 — 06_ <br /> FOR OFFICE USE; APPLICATION FOR SANITATION PERMIT <br /> Permit No.a,�/�� <br /> . <br /> --------------- ----------------------------------------- (Complete in-Trip1icatell <br /> --------------------------------------------------------- <br /> Date Issued ------ <br /> ------------------ This-..Permit Expires 1 Year From Date lssuecF <br /> ion 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 compliapr withy�ounty Ordinance No. 549 and existing Rules and Regulations: <br /> NA CENSV§ TRACT --------------------- <br /> JOB ADDRESS/LOC ---- - ------- - - <br /> JA'A __PVorR Z'6---3-1-1------------ <br /> -t--6&)---------------------------•----6wner's I Ul j- ----- ----------------- -------------- --------- <br /> Address Z-5---S-JD-----1"----- --- - ---1) ---------------_1 City ----- <br /> ----------------License # ------------------------ Phone -------------- ---------------- <br /> Contractor's Name ------- _e------------------------- <br /> Installation will serve: Reside.nce;nApartment House C] Commercial:E]Trailer Court <br /> I <br /> Motel []Other ---- ------------------------------------- <br /> Number of living units-------k---- Number of bedrooms" -- ---- Garbage Grinder ------------ Lot Size K----ta-S <br /> Water Supply: Public System and name ------------------------------------------------------------------------------------------- -------------------Private <br /> Character of soil to a depth of 3 feet: Sand'E] Silt Clay E] Peat El Sandy Loom -Ej Clay,Loam <br /> Hardpan E] Adobe 19 Fill Material ------------ If yes,type ---------------------------- <br /> (Plot plan, showing size of lotjlocation of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet) G <br /> PACKAGE TREATMENT SEPTIC TANK Size- ---------- Liquid Depth -------]------------------ <br /> art ents ------ <br /> Capacity 1,2_A_0__jPA-Type1Q96­Z--------- Material_601Ywee-e 6�40 Compartments . �------ <br /> 1 -------------------Foundation --- t---------- Prop. Line ---------------------- <br /> Distanc6 to nearest: Wel <br /> LEACHING LINE No. of Lines -_---c>Z------------ Length of each line-___I -?----------- ----- Total Length ___/ ._________._ <br /> D' Box ------------ Type Filter Material ---- Depth Filter Material __-41,4-k&4--------------------- <br /> -----10_ Pro e Line ___- - <br /> Distance <br /> --41,4-k&4--------------------- <br /> Distance to nearest: Well -------U6. Foundation -----Y'0_ ------ Property Line - - ----------- <br /> SEEPAGE PIT Depth ------- Diameter _3_a)------- Number _--_----.__t= ------------- Rock Filled Yes No No '0 <br /> Water Table Depth ----------9-0-1----------I----------------Rock Size ----1/_:-__11----------- <br /> Prop. Line --------- <br /> Distance to nearest: Well ----/0- Foundation <br /> _ _1------------------------ <br /> REPAIR/ADDITION(Prev. Sanitation Perm'lt# .....--------------I-`------------------------ Date --------.------.------------------I <br /> Septic Tank (Specify Requirements) --------------I---------------------------------------------------------------------------------------------------I----------------------------- <br /> Disposal Field (Specify ReqUirements) --------------------------------------------------------------------------------------- ----------------- ------- <br /> - <br /> ------------------------------------------------------------------------- <br /> ---------------- --------------------------------- - <br /> --------------------------------------------------------------------------------------------- } <br /> ----------------------------------------------------------------------------------------------------------------------------I.,-------------------------- <br /> (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-in accordance with Son Joaquin <br /> County Ordinances, State-A-iiw 'and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature cerrtifies 1-.1�following:I <br /> "I certify that in-the erForma Ze of the work for which this permit is issued, I shall not employ any person in such manner <br /> as to be or man's Compensation laws of California." <br /> Signed -------- Owner <br /> -------------- <br /> ByTitle ---------------------------------------------- ------------------------- <br /> I (If other an owner) <br /> PARTMENT.USE ONLY <br /> APPLICATION ACCEPTED BY - -- ----------------------------------- ------------- ------- DATE -----1� ----------;--------- <br /> BUILDING PERMIT ISSUED ------- - ----- --- -------- ------------------ --------------- -----------DATE <br /> ------ -- <br /> ----------------------------------------------------------------- <br /> DDITIONALCOM - -------! --------- -6 ---- --- - --- - <br /> -- ------- --- <br /> -- <br /> 4 <br /> ----------------------- <br /> 7ncIInspection by: ----- --------------- <br /> -- ------ - ------------- ----------------------------------------------------------------------Date ­� - ------------------- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6 ev. <br />