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FOR OFFICE USE: FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No <br /> ----- - ---------- .._7.y-131 <br /> (Complete in Triplicate) • <br /> ------------------- <br /> ------ ---------------------------- <br /> Date issued_-?- ---7� i <br /> ------------------______.__:_.._.__------------ --- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a.permit.to construct and.install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: _ # <br /> JOB ADDRESS/LOCATION- -----c 7__ !l).---- 0cf.11L �--- .�J --------------------- -- ---CENSUS TRACT------:------ ---- ------ <br /> Owner's Name__ � ..�/li� , :----- Phone �z/ � . <br /> --- ----- ------ <br /> Address... I � NIQr11` : -- °-------------- -. _ City 51„GT� Zip <br /> Contractor's Name -,_.fir _��- =-------- --Lice[� .# �s� r� _ • Ph on <br /> Installation will'-serve: Residence] Apartment House.E]. Commercial ❑ Trailer Court. ❑ ' <br /> r ..Y. . ._. . > Motel ❑ Other -------------------- <br /> ] . --- ----------- <br /> 11 s _Lo <br /> t Size � _--- <br /> Number of iving unit _ 1--- a Griner - -- - <br /> Private Su Iy: Public System andname---- ----- _p ------- - --- ----- <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ 'Clay ❑ Peat ❑ Sandy Loam L. Clay Loam IE <br /> Hardpan°] Adobe;❑ Fill Material- _...__.__If yes, type --------________--- <br /> _----------- l <br /> t c � <br /> (Plot plan, showing size of lot, location of system infrtelation to wells, buildings, etc. must be placed on reverse side.) <br /> \ <br /> NEW INSTALLATION: (No"septic tank ti�seep�age }I it�Tpermitted if public sewer is available within 200 feet,] <br /> PACKAGE=TREATMENT [ ] : SEPTIC TANK [ ] Sixe__ � - �'�===�--- ---- ;----------.Liquid Del pth-f __.__.__._____ <br /> CapacitYs TY pe ---' ----- ----=-----Material �Na. Compartments ----- --- <br /> ' --� Foundat.ion. a , -Pro L'-ine- ---------- <br /> E Distance'to.nearest: WeN.__��----------- -,. --.- p• r <br /> LEACHING 4 INE: [ ] No. 'of Lines_f ___ Length of each line..!!e___________________Total Le gth._ /4. 1`a___.___.____.__-______.__ <br /> - � .. <br /> : 'D' Box__:1_______Type Filter Material Depth Filter Material------_,-_. _________________________ <br /> Distance to nearest: Well___�(�__ ___________Foundation._-/110--_._______________.Property Line_: er----_------___ ___. <br /> l ~ <br /> SEEPAGE PIT [ ] Depth. �3_ Diameter___ -- _Number... ___________________ Rock Filed Yes No ❑ <br /> } f. Water Table Deptlh_ '= -------.--- Rock Size---------------------------- ----- ------: <br /> E <br /> x 'Distance.to nearest Well---- --=---- --------------------_------.Foundation---------------------------Prop. Line--------------------_---. <br /> REPAIR/AD'DITiON (Prev. Sanitation Permit#---- Date.---------- ----------- . -------.--------:_-_)i E ! <br /> Septic Tan (Specify Requirements)-----_-..,. tr.T--- {-=-�------------- --- <br /> Disposal Fi#ld (Specify.Requirements)..- �' - ----- -------------------------------------------------------------- <br /> ----------- <br /> ------ ----------- ---------- <br /> ----------------------------- -:-- <br /> - - <br /> ----------- E <br /> r } � _ ---------- -- --- <br /> --------- <br /> i ----- -- --------------- <br /> ---- ------------ I--------- - <br /> (Draw existing and requkicl addi#idn�on reverse`side) <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with $an Joaquin County <br /> Ordinances State Laws, and Rules and �tegulations of.the: San JoaquinlLocal Health District, Home owner or licensed agents <br /> signature certifies the following: l <br /> "I certify thfa -n-the-pei'forrrionce-of-thi2-w ark for which this permit is issued, I\shaif not employ any person in such manner as <br /> to become Isubje to Workman's Compensation,laws of�Califo <br /> Signed----�' ` - _--------- ` :' -::: Ownar . <br /> - _ " <br /> ;. =�, Title 7 <br /> (If other than Tier] - > '' �> <br /> �----�— -FQR�3EP,ARTMENT USE ONLY' - t <br /> r '7 <br /> APPLICATION ACCEPTED BY-----�! --- ---- -� ------------------- --------\- DATE.'_t4-- _- <br /> DIVISIONOF LAND NUMBER--------------------- ---- - ------------------------------------ ------------.--------- --------------- ------------ <br /> ADDITIONAL-GOMMENTS- _- — - <br /> ----�-=`- 1. <br /> ` 1` - ----_- -1 -5 ...... = ------------ <br /> ------------ <br /> t ------------ - ------- ----------- - ---------- --- --- <br /> -------------------- <br /> Final Inspection by:. _= -- y = _ °` Date: = <br /> Fos 2ie�� 7 <br /> EH 13 24 . USAN JOAIN LOCAL HEALTH DISTRICT � <br />