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FOR: I:Ic tis APPLICATION FOR SANITATION PERMIT 1 <br /> .,..�.�#, ... Permit No. ...ZG_._y 7 <br /> _ „ f .. . - _ lcompletein1riplicatel - x . .... ... ......... <br /> ..........I....................... -•••--•............. Date Issued /6 iy 76 <br /> ......................................................... . This Permit Expires ] Year From Dale Issued <br /> i <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. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ., 2C_0_-_ ... � .r its ---------------- ........CENSUS TRACT _-_-------------------• ' <br /> Owner's Name ..............�_ _ ...............--•-.........r--..---- -- Phone ...... - ------ <br /> ..�P _. <br /> Address � �� _ �`_ ----• ty �`�a-1-`-J-------------- <br /> Contractor's Name ... .'.E_- _�_. :t J. ....License ..................:..... Phone <br /> Installation will serve: Residence to Apartment House 0 Commercial❑Traller Court ❑ <br /> Motel ❑Other .................................­'.­1 . , <br /> f� -2-,p-j- K <br /> 4 <br /> Number of living units:__-]------ Number of bedrooms ----...Garbage Grinder ..---•- Lot Size ----------•---------------------------••--•- <br /> f Water Supply: Public System and;name <br /> --------- - -------------_..._._..----------__...--- -- .........................................Private <br /> Character of soil to a depth of 3.feet: Sand b Silt 0 Gay ❑ Peat❑y Sandy Loom ❑ Clpy Loam <br /> - <br /> E Hardpan❑ Adobe tk Fill Mater€al ............. If yes,type............... ............ <br /> )Plot .plan, showing size of lot, location of system in rotation 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,)� �r <br /> PACKAGE TREATMENT [ ] SEPTI TANK Sze_ '� �. .................... Liquid Depth -----••----•• --...-- <br /> 1 .................-- 1 <br /> P�A <br /> Capacityl��Q........ Type ° . MotorialCaa-�- ..... No. Compartments _ <br /> Distance to nearest- Well .. ..[.. Foundation ....... Prop. Line l _..._ <br /> LEACHING LINE No. of Limes - Z-... Length of each l€ne--a--sem-- .. Total Length .. ---•-,•- <br /> r <br /> 'D' Box. ..:it ... <br /> , <br /> -- Type Filter Materials -4a .Qe Depth <br /> . .. Material J-fi .`f <br /> -_ <br /> ll .0-z' Fou dation Z __ . ........ Property tine ..... <br /> ..Distanceto nearest: We .._---•-- umher -•---ar �. - Rook Filled Yes No SEEPAGE PIT Deptha. - ? '_ ___. Diameter�..-_ • <br /> O <br /> T <br /> 1 � . <br /> Water Table Depth -------------Rock Size --- -Z.f? ------------- r <br /> Distance to nearest. Well _.. ..__._Foundation _._ .�'.... Prop, Line ....- ...___._..- <br /> I <br /> R9PAIiR/ADDITI0N(Prev. Sanitation Permit# .. Date . .......:........... ) <br /> -------- <br /> Septic Tank (Specify Requiremthts) -•.................----.......................................................----------------------------------------------- f ....... <br /> 1 <br /> Disposal Field (Specify Requirements) .-• -----------------•-------_•-------------..---• -------------------------------- _.... <br /> _ ---------------- ---•----- ...................................... ...............---------------._........................ <br /> ............----------------------------------- -----------..------------------------------- ............-..........I......... ............._.........._................:--••• ---•---- <br /> i (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 San Joaquin <br /> County Ordinances, State Laws, and Mules and Regulatioris of•tEte Son Joaquin Local Health:District, Home owner or licen- <br /> sed agents signature certifies the#ollowing: <br /> 1 "1 iertify that in the p ormance'of the work for which this permit is issued, I shalt not employ any person In such manner <br /> as to 6ec a subject t orkma�n/'� Compen tion law of California." <br /> t Signed _._LV`�.Er[ ._._._ .- �_.. ...... -• -•-- --------------- Owner <br /> 1 x .. . <br /> .- <br /> $ • ------------ Title ---• . --- ----------- ............... --------------_------ <br /> - <br /> 4 (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED. BY ------------_7 ........ DATE ------- <br /> BUILDING.PERMIT ISSUED ------- "--------------•--..-_ ... ..._............. ....•-..................DATE ._ ................................... <br /> ' ADDfTIONAL COMMENTS -----_----!-..- - <br /> •--------k-------_ - ............................................ - <br /> ---------- ...... . ... .... .... <br /> VUI'N <br /> ..__.._._---_-_ ----- <br /> - -- --- .. <br /> Final inspection by. .......:. ......._ _ Date _. ----• - •-c <br /> EH 13 2L 1-6$ -. SAN JOA LOCA€. HEALTH DISTRICT 8/74 3M <br />