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-'FG°R OFFICE USE: <br /> w APPLICATION FOR',SANITATION PERMIT1f�3 <br /> � s <br /> Perm it;No: - <br /> �- ----- """" (Complete in Triplicate) <br /> � =�," �' <br /> ------ ----- ,�------- A, r„-..�.'i' Date Issued <br /> ' This Permit Expires 1 Year..From-Date issued <br /> ----------------- <br /> is he eby made to the San Joaquin Local Health District for as, perrrtif. #o construct and install the work herein <br /> described. This_a application is made in compliance with County Ordinance N6 "549 and existing Rules and Regulations: <br /> pp rFf- ` . S S 1# ' <br /> CENS U ! TRACT <br /> r }1 , „ - - <br /> JOB ADDRESS/LOC N __ _� 1 s I. I <br /> ------------------------- <br /> - - `Pho e <br /> 3 Owner's Name ---- - -------- ` _.. r <br /> "" = City /`� ✓r� 1 <br /> .� <br /> Address .... <br /> ,, - f; Lac nse #�� � Phone ,a <br /> Contractor's Name ___---__ F �s� n'" <br /> Motel Other__ __;__e❑ Commerc�a! ❑Trailer`Court. ❑ <br /> --- <br /> - f <br /> Installation Will. serve: Residence artment Hods <br /> Number of living units:__" '."" Number of bedrooms "---_Garbage G:r,inder .__ _O"" Lot Size/� -- -ems ----------- <br /> Water Supply: Public System and n�e�--------------- � -------=-- - -------------- rivate„[L}^- <br /> Character o soil to a depth of 3.feet:' Sand❑ Silt❑ Clay ❑ Peat_❑- Sandy Loam ❑ y Loam ❑. t <br /> y..�... .....-. �i 0 <br /> Hard an Adobe Fill Material ------------ If If yes, type - <br /> Clay <br /> (Plot plan, showing size of1lot�location of system in relation to wells, buildings, etc. <br /> must be placed on reverse side.} <br /> .r I <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] . SEPTIC TANK f I Size------------------------------------ --_ &-Liquid Depth -------------------------- )J <br /> ------- <br /> Capacity Type --= Material----------------- o. Compartments <br /> PY ---------------- a <br /> L. Distance to nearest: Vll- ------------------------------------Foundation.1 �_�----- -.w;-- Prop, line __..��------------{- <br /> I <br /> LEACHING LINE No.. of.Lines --- -------------------- Length of each line-------------------.------- Total Length -------- ............ <br /> Type Filter Materiai ____________________Depth Filter Material - er L <br /> 'D' Box - ------ Yp ------- -------------------------------- <br /> Distance to nearest: Well ------------------------ Foundation ------------_------- p ty ine"------------------------ 1 <br /> i ---- <br /> 1 Depth Diameter ________________ Number Rock Fiiledjees ❑ No i <br /> SEEPAGE PIT { 1 p ----------------- (J`rr <br /> Water Table Depth ------------ -Rock Size -------------------------------- Y` <br /> - Pro .� <br /> ------------------r--------------- Line _k�.....------------ <br /> Permit�# ---------------------------------e- -----'--------=- } F <br /> Foun anon <br /> Distance to nearest: Well ------------------ ------------- Date - -----------•------------------- <br /> Septic <br /> ------ _ <br /> REPAIR/ADDITION(Prev. Sanitation = <br /> --------- <br /> -- --- ----'r --------- --------- <br /> 4W <br /> "------- <br /> Septic Tank {specify Requirements} ________________________ ` - ------- --�_ <br /> Disposal Field (Specify Requirements) ---- �iC,(_-.-----`T-�------Q -f _ _ JG <br /> u ------------ -----------------------------•----------------- -� -----------------------•-------- <br /> - `' <br /> --- -- ----- g-.--- __ -- - - <br /> ------------------------ - ------------------------------- the work will be done in accordance <br /> {Draw existin anreq <br /> d required <br /> addition on reverse side) <br /> Lr <br /> I hereby certify that I have prepared this application and thatwith San Joaquin <br /> County Ordinances, State Lavers, and Rules and Regulations of the San Joaquin local Health District.'HdMe owner�or licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any peFson in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -- ------------------------- = Owner ! �i <br /> B ----- = .Ti tl e--------- - --:--- <br /> (If other t a owner) , <br /> PAftTMENT.USE ONLY <br /> APPLICATION ACCEPTED BY ------ ------ -------------------=------------------------------- DATE ---- .--f-`_7/--------------- <br /> -- --- -- - - - - <br /> DAT <br /> BUILDING PERMIT ISSUED --------- <br /> - <br /> ADDITIONAL COMMENTS ------ ------ -------------- <br /> ------------------------------------------------------------------------------- <br /> ------------------------------ ------------------ ----------------------------------------------- --------------------------- <br /> -------- - - ---- ---------•---- ------ --- ---- ------------------------ ----------------------- ------------- --------------------------- -- -- -- -- <br /> ------ <br /> Final Inspection b --""""" .Date <br /> S OAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />