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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` <br />.................:............................ Permit NoY�Xl <br /> (Complete to Triplicr�te) _ _._. _.. <br /> ---•---- te <br /> ----. ..................... ......• This Permit Expires 1 Year from Dalssued Date Issued ... <br /> �� <br /> ��� <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 /> �07 <br /> JOB ADDRESS/LOCATION . ................._-..----�1 . . .... ......---......_......_^.............CENSUS TRACT ........------------....._ <br /> Owner's Name -.. ` r...............,. .................Phone <br /> Address ..............•---•--...._ -` ....� -�........-- •-........ ...,---. ,City ..... . .. ....�--...-ss,�- ..__..._.. ....... <br /> Contractor's Name r"'..-..� 3 ��.._ ........:..........License t4` ..........-....... Phone ....7� !��.-, t?p <br /> Installation will serve- Residence0Apartrnent Houset] Commercial❑Tra€ler Court <br /> Motel ❑Other.......................................... <br /> Number of living units:------/ Number of bedrooms Garbo a Grinder ... 'go <br /> ' ......... .Private ❑ <br /> Water Supply: Public System and name ......... _-------------------------- <br /> - - . <br /> Character of soil to a depth of 3 feet: Sand b Silt 0 Clay [) Pea © Sandy Loam {] Clay Loam <br /> Hardpan❑ Adobe 0_ Fill Material ............ If yes,type ............... ............ <br /> 1PIot plan, showing size of tot, location of sysfe—M in relation to weliss„buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: <br /> (No septic #ak�pr seepgFgpit'permltie$'if"p1f5fawer is available within 200 feet,} <br /> ... . <br /> PACKAGE TREATMENT [ I SEPTIC T` NlC I ] size................................_•.......... Liquid Depth ................ .....-- <br /> Capacity Type Ma <br /> terial No. Compartments <br /> ....... -••--------------- <br /> Distance.to nearest: Well -----...............................Foundation ...................... Prop. Line ...._ ................ <br /> V�1 <br /> LEACHING LINE [ ] No: of Lines ------------------------ Length of each line.------_------------------ Total Length ............................ k <br /> D' Box_.,. Type-filter-Material-7.-::...----• D6pfjf7Filter Maferiai:r................. ..... = <br /> _, <br /> 4 - <br /> Dis ante to nearest• Well - ..--Foundation .. property Line ... <br /> ... . <br /> i I"�A <br /> SEEPAGE AIT [ l Depth -------------------- Diameter ....__...-....:. Number ...:----:-.-----. ._.-...... Rock Filled Yes ❑ No <br /> ., <br /> Water To "le Depth .....`----------•---•---•------------------= t dc-Size ................. <br /> I <br /> i <br /> Distance to nearest: Wel ............... .•---------...-----..:-F2aundation ------ <br /> ......-.... Prop. Line ...................... <br /> t �. <br /> REPAIR/ADDITION)Prev. Sanitation Permit* -------------ti------•-<.--e - Dale............................-----�•) <br /> tc r <br /> Septic Tank (Specify Requirements) ' ::. ...............•--:...........:> ............------.....----.......- <br /> Disposa! fie {Sp Ify Reyuiremen s)�__Y:� 4-- --- . <br /> 1 - <br /> ....................... <br /> i It Y <br /> rt <br /> 1Dra- existin and required addition on'reve'he side) <br /> tJl, <br /> I hereby certify that .I have prepared this appiliation and th6t the work will be.done in oeeofdonce with San Joaquln <br /> County Ordinances, State Laws; and! Rules and '.Regulations of the San loaqulr% Local Health:Distilct. Home owner or Been, <br /> sed agents signature certifies the following: k <br /> "I certify that in the p ormance of the.work for which.this-.pedmit S lssued, i slhall not endplay any person in such manner <br /> as to bee* a sub edorkrnan's Compe laws of alifornla:" 4,,, C� I <br /> Signed — ---- ------- ..... <br /> Owner <br /> BY e- ------ Title <br /> .. ... ................... <br /> --------------- ----------- =_ <br /> llf other than owner), ` <br /> I FOR DEPARTMENT USE ONLY . <br /> - .... OATE ...3 .. G......----------- <br /> APPLICATION <br /> ACCEPTED BY -. _,_;. -- <br /> BUILDINGPERMIT ISSUED ------------------ -•--------'--------------- ............--...................-.-...................DATE......-_--.-.-..------------- •-•---••--- <br /> ADDITIONAL COMMENTS ----•----•---- -- `"'-..'.:_^...r..t. -- '_�.'. '.;.... <br /> .. *� r ---------------- ......................... •------ <br /> --•-•-----------------------•-- ---.....-...-------- .-------- -------------------------•--------•- ----------- -------•--•---------- • <br /> _.--.......:. <br /> Final Inspection by: PDate .... .. .�-....-...... <br /> EH 13 2h 1-6£3 Rev,Ae. <br /> SAN JOAOIJIN LOCAL HEALTH DISTRICT 8/74 3M <br />