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u-SYR•,,.-a-.ll'�-r .. - h <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit No. ........ .....7... <br /> (Complete in Trlplicatel' ,6 <br /> . .- :�_ <br /> w <br /> ............................................ Date Issued .. <br /> .................................................. <br /> ::_.... ._.. <br /> This Penult Expires 1 Year From Date Issued <br /> strL; l the <br /> Application is hereby made to the,Son'Joaqu n.o l Health <br /> ith District <br /> i tri t for <br /> -.a permit <br /> it t .nocon <br /> existing Ru1esand talnd Regvlottiions. 4 <br /> described. This application is made in compliance <br /> l' <br /> .CENSUS TRACT ....... .. <br /> J013 ADDRl=5S/LOCATi N..p -y. ,.... .. .. <br /> one _ _-------- <br /> Owner's Name ,. <br /> i <br /> ... ..City ........... .. . P.,. : -----•..........__......,. <br /> Address �0� - <br /> Phone ._..._ <br /> Contractor's Name -_--- -- - - `' <br /> !..License <br /> Installation will serve: Residence Apartment House] Commercial OTraller Courte (3 <br /> Motel 0 Other - <br /> . � .....Garbage Grinder ............ <br /> Lot Size <br /> �.... . ................... <br /> Number of living uNumber of;bedrooms :f <br /> . .... ....Private <br /> Water Supply:.Public System and name .................:..._............--_.--.._ -.. ........... � <br /> Character of soil to a depth of 3 feet: Sano o i It Clay p , Peat(] Sandy Loom fl Cloy Loam ❑ r <br /> { E Hardpan Adobe fl Fill Materia! ............if yes,type <br /> ............... ............ <br /> f system in relation to wells, buildings, etc. must be placed ;on reverse slde.l <br /> f (Mot plan, showing size of lot, location of y <br /> Na septic tank or see age .pit ,permitted i ublic"sew er'is available within 204 feet,) <br /> NEW INSTALLATION: { p <br /> �..._..�....—, ,�_. 5........ Liquid Depth ......- <br /> PACKAGE TREATMENT I. SEPTIC TANK[ <br /> Size.. .. .. _ . ... . , <br /> C j <br /> c o 7 e �1, .�. Material ---.•• No. Compartments ..e�--(----•---- <br /> e _ Co acs l!�-- -�"=-` Yp ..------•-•- -•.......:........ <br /> M Distance.to nearest. Well S.��!. ...... undation _'. - - ---- i <br /> Fo Pr p. Line <br /> }, Total Length ._ _ • <br /> .��-------------- Length of each litie...:-....�- -. . <br /> LEACHING LINE [ 1 Y No. of Lines .... - - <br /> D' Box Type filter Material .. S •• p - 4 <br /> .._.Qe th .filter Materia! .... f......_....� ..... <br /> ... .... <br /> Distance'to nearest: Welll� Foundation -- �.S? -Y ---. Property Line 1 <br /> .� ,�:.'_:..... Number'_...._ . Rock filled Yes [ NO 0 <br /> r SEEPAGE PIT [i� Depth .., ___.- Diameter :1, � ;.. <br /> Water Table Depth • =...... ---•-•..Rock Size _� .... ._............ <br /> a- ! <br /> z Distance to nearest: Well Foundation �. .....-•-..'.'Prop. Line ...... <br /> ..... 1 <br /> Sanitation. Permit r# ................:. Date _......._---_......:_..-......-- <br /> ItEPAIR/A13DlTION(Prev. --- . -•-•------•---- - � <br /> T _ , <br /> Septic Tank (Specify Requirements) <br /> Disposal Field (Specify Requirements) ---•••• ........... ..................................... <br /> -..----••-•------ - --------------------• ---- ....---•--•-_••--•--•-.....-- <br /> ?. <br /> -:_.:... :...:.. ... <br /> {Draw existing and required addition on reverse side) <br /> 1 hereby certify.that ! have prepared this 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:Dlstrict. Home owner or licen- <br /> sed agents signature certifies the following: erson in such manner <br /> "l certify that in the.performance of the work for which this permit is issued, l shall not employ any p <br /> as to become subject to Workman's Compensation laws of California." ` <br /> Signed ------ Owner <br /> // /' <br /> -- - -- �� Title _ f <br /> ----------- <br /> t -------------------------------------------- <br /> Of other than owner, <br /> s FOR DEPARTMENT USE ONLY <br /> �a DATE 3-!?:. ............ ._----- <br /> APPLICATION ACCEPTED BY -. 4�`-- �' = _. .: Y <br /> BUILDING PERMIT ISSUED-- -----------• --- _. ' -°--__ <br /> _t., .. DATE. ..,.. ._.__._... = <br /> ADDITIONAL COMMENTS . -�_`�`-`713..... •----•. '' --4 ,... <br /> ----------•-----.....-- -•--------------------•----•-_-. •-•------------ --•---- ----- . <br /> G -----------------------•--- ----....__ ---•---••-._:.._=____...- ----•-----. -----•-•----...-•- ---••-•----._...:-.--....---��-----•---•-----.-i']ate.,�.. .-ice .-��_...__...._.----. <br /> Final Inspection by: -_-__I <br /> •-...... ....... � ... <br /> ' 13 2!t 1-613 Rev. 3 SAN JOAQUIN LOCAL HEALTH DISTRICT 8�7� 3M <br />