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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> G <br /> ......................................................... <br /> 7s�- az S <br /> (Complete In Triplicate) Permit No. ..... <br /> Date Issued . <br /> / -61/-7S- <br /> 6y� ..... This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the Son JoanIA Local Health District for a permit to construct and Install the work herein <br /> described. This application is made In complibnce,with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATIO �D.. _-C.� _ .. <br /> ... . .......... CE <br /> - T r <br /> t Owner's Name `_ Phone q7 ........ <br /> Address .................. do � ` '...'. ........ City .. ...... <br /> . .�.._.. U 7 `� q <br /> Contractor's Name �l.a:K...... .........:........License 5� �1 l,>.... Phone'.T41r ..:l--i07.. <br /> F ..._... --- •- -•---. .. <br /> Installation will serve: ResidenceXAp-artment House Commercial []Trailer Court �] f <br />} Motel❑Other x~'- <br /> Number of living units: ..�:..*_ Number of bedrooms . :....Garbage Grinder ....:....... Lot Size.. .. .. <br /> ... i. <br /> Water Supply: Public System andFname ------------1­ <br /> ...�.........P_rivate�] . <br /> Character of soil to a depth;of 3 feetSand❑ Silt❑ Clay ❑. JPeat❑ Sandy Loam ❑ Cloy Loam ❑ <br /> Hardpan❑ Adobe 1] Fill Material If yes,type <br /> i. <br /> {Plot .plan, showing size of lot, loc t oce of system In relation to wells, 'buildings, etc, must be�plaied on reverse side.) <br /> NEW INSTALLATION:. (No septic tank or seepage pit permitted if pub!c e ver�is availablo within 200.fee J j <br /> o r ( r <br /> PACKAGE TREATMENT [ ], SEPTIC TANK ize.:_____ � ../....r.................. Liquid Depth ..........:.t..� <br /> ! Capa�eity!. .'....j... Type Material_ I�__4,- .., No. ,iComportments ° y <br /> it t f f ` ........++......: <br /> i <br /> i Distance to nearest:-Well .......�D..... . ......... . _ l� Prop. Line . <br /> LEACHING LINE No. of line's ._ __ •... :_..: Length of e��ach line....: 's.��......... Total Length f-.-1.7 ..............9 <br /> ✓rType�Fdter Material _j -,6eA-____Depth Filter Material ...l..d'..I.......................... ..� <br /> r r �t i <br /> t f <br /> Distance to nearest: Well _: �'`" `� ..�............... <br /> , .....:....... Foundation .....�:Q............. Property Line 9-1 <br /> SEEPAGE PIT Depth ..... ..... Diameter ,t7,J3, Number ........ _y......... Rock Filled Yea No b p <br /> ... <br /> Water Table-Depth.................... .....'. :..:......Rock Size .��...x..L..t!�...._.� � <br /> �, <br /> Distance to nearest: Well . l�_._ . :Foundation ' P �f e <br /> i Prop.. Line <br /> ............... :. <br /> i RfPAlR/ADDITION(Prey. Sanitation Permit#1..:................:.....:...................Date ..... <br /> Septic"Tank (Specify Require em nts} ..........................................� ........_...: <br /> = .. � <br /> Disposal Field (Specify Requirements) ...(... ......................:.•-•-.............................-____...................... ................................ , <br /> •••---.... .................. -- ._....... ........ ...... -....... -- ..... <br /> ........ --•--•._.._._..-••-•--•--•---••-----•---•.. . ......................• -•-- ......... . ......_._..- ••••--•-••--••--••••----•--•- ••.. .......... <br /> ..(Draw-existing and required addition on,-reverse side) <br /> I herebycertify (haul_have prepared this application and that the work ,will be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and It gulations-of-the-Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies the following: ' <br /> I "I certify that in the performance of-the wark'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 /> Signed :...... ........ Owner <br /> 441 <br /> By _...___. _ Title <br /> •-• ._ _±__________ ___ <br /> F -------------------------------- { <br /> (If �an4owner) jI{[r <br /> I FO EPA MENT USE ONLY <br /> APPLICATION ACCEPTED BY .. ._....:..._._._..._................... .... DATI= <br /> BUILDING PERMIT ISSUED .......................- ..........•-•-•-•....-------•-.------------•----....... <br /> ..................... <br /> ADDITIONAL COMMENTS --------------------•••--:_.. ..... ............................... .......................... <br /> r : ti <br /> .....................................`.'...---- - .} 1.\1 °> }, R..... ................................... .-. .... ..... � ... <br /> ................................. r . .. ...................... ......_........... ................ ......... <br /> Final Inspection by ..... •pate ,l% � f <br /> — - SAN JOAQ OCAL HEALTH DISTRICT <br /> i <br /> c_ u 13 24 r_•� o_ - <br />