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FOR OFFICE USE: <br /> ro APPLICATION FOR SANITATION PERMIT <br /> --------------------- ----------------------------------- <br /> (Complete in Triplicate} Permit No. <br /> -- -------------------------------------------- <br /> --------------------------------------:--------------- ThisTermit Expires 1 Year From Date Issued Date issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to c43n­sW6fft­-dind-ifi-sta 1.1 the work herein <br /> described. This application is made in compliance with-County Ordinance No. 549 and existing Rules and Reg"ulations: <br /> .S-qq le F Rjy>01V <br /> JOB ADDRESS/LOCATION ------['�.0------------CENSUS TRACT <br /> Owner's Name ......I---------I 2i A A Diu—------r--R__ _.f-)------------------------------- -------------------------------------Phone ----------t_--------------- <br /> Address ------SLI9,&--------- ------P, -------- city ------MAIWE�E --------------t------------------ <br /> Contractor's Name -------OW fv.ff R--- —----------------- ------ --------------.­------'-1icense # ----- --- -------------- Phone .----------I------------------- <br /> Installation will serve. Residence E] Apartment HouseLj Commercial :oTrailer Qewrt <br /> Motel E] Other,------J---------------- ----------4----------- <br /> M -_ f <br /> Number of living u1nits-_W----- Number 6VPear6�f k,4-a---!�Garbagl Grinder Lot-Size ------------ <br /> Water Supply: Public System and -:I V I j•---Priv <br /> name -- ------ -- - ------------------------------------------------------------------------------- ate <br /> Ia'y 1-010MIE1 <br /> Character of soil to;a 6pth of 3 feet. - Sand'[:] -.-Silt Ej -Clay -E]. .,IPeat F� Sandy Loom.-T::�I_c <br /> Hardpan E) Adobe-E] Fill Mciserial If yes,type ------ ------ <br /> 57, <br /> (Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc. must be Odced' on reyerse side.) <br /> NEW INS'TALL;kTION: (No septic tank or seepage pit permitted if public sewer is available within�200 feet&,� <br /> I I TAI . :a- <br /> PACKAGE TREATMENT [ ] SEPTICIANK;Ie� Size/-- —----------- Liquid;Depth '__.Ze� -1.............. <br /> N10 <br /> Capacity 1200---- TypeMEC <br /> ft-ST MateriaI<1?PKRET_E_No. C pa m nts <br /> 0Line <br /> . ........ <br /> I Prop. LinW <br /> Distance to nearest. Well ------1�?, __`----------------Foundation- -------- J� -------- <br /> enp <br /> IL th, <br /> J <br /> 'D' Box .- -_ -------------------------- <br /> LEACH NE No. of Lines ZLength of each line-------749--- Total ------- <br /> .11� <br /> Type Filter Material Depth Filter Material <br /> Distance to,nec rest:,Wel I- -------- Foundation ----/ ------------- Property N Line;,L__1 --------- <br /> SEEPAGE PIT -------1 1------- --Diameter 1_,�!----! '.__--Nbmber ---------------- ----------- Rock Filled Ydis t] 0 C] <br /> ell <br /> Water Table Depth---n---------------===-------------------- ••Rock Size ------------------------ <br /> Distance to UiUst: Well ----------------------------------------Foundation -------------------- j*dp. Line ----------_-_-- <br /> REPAIR/ADDITION(Prev. Sanitation Wmit# -------------------------------------------- Date ---------------------------- <br /> Septic Tank (Spec,ify Requirements) <br /> ------_------------------- ----------------------------------------------------9------------------I--------- ------------------- <br /> Disposal Field (Specify Requirem s) -----------------------(!---------------- --------------------------Z--------------------------- \�------- --------------- <br /> -------------------------------------------- Ir ----j------------------- <br /> -------------------------------------------------------------------------------------------------------------- ----- - <br /> r kit- <br /> -------------------------------- -------------------------- ------------------------------- ---------------------------------------------- ----- ----------------------------------------- <br /> ----------- <br /> raw existing and required addition on reverse side} <br /> I hereby certify that I have preparedthis application- and that'.the work will be done in accordance with San Joaquin <br /> County Ordinances,,State Laws, and I iules and Regulations of the Son Joaquin Local Health Disirict. H"e owner or licen- <br /> sed c 11 <br /> sed agents signatuertifies the following: 1 <br /> "I certify that in then e orm 6Uthe work for which this permit is issued, I shall not employ anersbn in such manner <br /> 1 ;1 sation laws of California 1 y p <br /> as to beco bi m a <br /> Signed -------- - - --- ------ --- --------------------- owner- <br /> By -----------------I------ -----------------------------------------------------------7TA 0- Tifle ------------------------------------------------------- ---------------- <br /> (If other than owner) I <br /> ........... <br /> FOR DEPARTMENT USE ONLY <br /> 7 <br /> APPLICATION ACCEPTED BY ----- T 7R, a---------_------ -------------------------------------------------------- DATE J----- <br /> BUILDING PERMIT'ISSUED ------------ `-- --------------------- - ---------------------------- ----------------- --------------DATE ........... <br /> 'ERMIT`ISSUED <br /> ED <br /> ADDITIONAL COMMENTS 14 <br /> - ---- -- --- ------------ 2------- ------------------------------------------------------- ------ ---------- ..... -------- <br /> M <br /> -------------- ----------------------- ------------- - _ ----- - - - --------- - --------- <br /> ------------ ----------------------------------------------------------------- - <br /> ------------------------------------ ------ ------ ---------- -- - ------ ---- - ------------------------------------------------------------- ------- <br /> - ---------------- ---------------- <br /> ...... .... <br /> --------------- ----- ---------- - - --- --- ------ ----- ------------------------------------------------- <br /> io <br /> --------------------------------------Date <br /> Final Inspectio - ------------ ----- -- I.-h---- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />