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' FOR OFFICE USE: K <br /> APPLICATION FqR SANITATION PERMIT <br /> ----------------- --- .. <br /> (Complete in Triplicate) Permit No. <br /> ______________________________________-___.______-_____ This Permit Expires 1 Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construi t-arid'Vln'stall the work herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing-Rales and Regulations: I <br /> JOB ADDRESS/LOC ION . ! 1_ ---�•�----- C,t�-F<�WRR04TO------------------- � t.. -S- `--4C? <br /> . - _CNSUS E7RACT R <br /> [� 4 <br /> Owner's Name//��jj G�� F --------------------- C.......Z,:-v."-------=-•------------------Phone <br /> Address -- -- --/ /{#/ (.2-------5------------ _ G- ltl� . City ------E ----=-------------------------------------------•--- I <br /> Contractor's Name --------O4 I(� ----------------= -------------------------=--------License # ------------------------ Phone ------------------------------ <br /> Installation will serve: Residence Apartment House E] Commercial❑Trailer Court ❑ <br /> Mote[ Other ------------- ( ---------------------- <br /> Number of living'units:__/------- Number of bedr--------------------- <br /> oms_ Garbage Grinder.. iCl--- Lot-Size �A_cre ------------ <br /> Water Supply: Public System and name ___________ _ __ ____ __ _ `i__________ ___Private <br /> Character of soil to a depth of'3 eet- Sand'El Silt❑ - Clay E] Peat Sandy Loam Clay Laam ID - <br /> -Hardpanj`, Adeiae 0 Fill Material _ If yes, type ____________________ <br /> (Plot plan,.showing size of lot, I_ocat,ion of system„i, relationt to wells, buildings, etc. must be placed' on reverse side.) } <br /> �.16k <br /> on <br /> INSTALLATION: (No septic tank or seepage pit'permitted-if-.public..sewer_is.avaiI able within..200.-feet,] <br /> PACKAGE TREATMENT <br /> [ 7 I TANK'[ size------------------------------------- Liquid Depth --------------------------Capacity � .� <br /> - 10 <br /> ------------ Type - ------------------ Material -w- - = o. Compartments <br /> tonearest: Well __ ________________________________Foundation -------- __________ Prop. Line ____-.__...._:__------ <br /> LEACHING LINE [ ] No. of Lines _____._-__--_---------- ength of each line.__________-_______.__.__ Total Lengt''h _ <br /> _____________ _.____....__. <br /> I 'D' Box _ _ _____�- Type Filter Material _Depth Filter Ma rias <br /> t a <br /> Distance to nearest: Wel) _____ __________________ Foundation -----_------------- ___ Property Line _0----------------- <br /> r , <br /> SEEPAGE PIT [ ]; Depth --- ------------- Diamete _______________ Number ______._ -------------- Rock Filled Yes ❑ No 0 <br /> Water Table Depth ----------- Rock Size ------------------- <br /> Distance <br /> � t <br /> Distance to nearest: Well ------ --------------------------------Foundation ----- .---------__ Prop. Line ----------------___--- <br /> REPAIR/ADDITJON(Prev. Sanitation Permit <br /> Mr, <br /> y # -------------------------------------------- Date - -4 -----�r--=_:-,' <br /> -J______________j <br /> ,PticTal( .(SpecifY Requirements) � ---- �-jr <br /> ------- <br /> Disposal Field (Speecify <br /> SpRequirements)� -SX�rT � <br /> S P`nc.3 t n 1�1------�- ---”-----�- L -CIS------ /_f�. --' l �f--------------------- <br /> � s 4 <br /> --- ----------- ---- ------ ---------------------__ - - - --- ---- - <br /> - �---------_ � (Draw existing and reqwired addition - � Y <br /> 4 g dition on reverse side] <br /> I hereby certify that I have prepared jhis application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies t following: <br /> "I cpify �,_S��nerfor n of the work for which this permit'is issued, I shall not employ any person in such manner <br /> �t t d''l 4{ .'''s <br /> as to Wo an s:Comp±lnsafion�_laws of Cahforriia. ` <br /> Sign ------ - --- -- ----- ----- <br /> Owner <br /> BY ----------- 11 _ <br /> ,p 1 <br /> (If other than owner) " <br /> FOR DEPARTMENT,USE ONLY <br /> APPLICATION ACCEPTED BY --------- -----. DATE ....5__------6 -- --- --------- <br /> BUILDI:NG=-PERMIT•-ISSUl_D=t=-=' ==-=DAT.E_-_.___ -- <br /> ' — -- ----------------- <br /> ADDITIONAL COMMENTS <br /> ---------------- <br /> -------------------------------------------------------------• ---------. <br /> -------------------------------------------- =C f-' . "/ _. t9 t4 # 3_-' . 7. ! __ \ .{ <br /> �t = <br /> ----------------------- - -- T'---'---"-"'— �-.•^` - ..... ....._..._.. r- -,-;�---b:w �.... - <br /> Final Inspection by: ___._______.____ _ _ Date _.__ .__ <br /> - _- -- --------- _'. ---------------- <br /> _16 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M <br />