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FOR OFFICE USE: APPLICATION FOR: SANITATION PERMIT <br /> ------------------ ------------------------------------ sF. Permit No: --------------------- <br /> (Complete in Triplicate) <br /> ..........�­-------------------------------------------- 7 <br /> This Permit Expires 1 Year From Date Issued Date Issued __�_-9_'7 <br /> --------- ----7---------------------------------- <br /> Ap liccifi" is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> P on, <br /> described:This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION - --- <br /> /'o-ew . ..___._CENSUS TRACT- -------------------------- <br /> ------ <br /> Owner's Name ---- ---------------------------------------------------- ---------- Phone',M_-2 2?,_ <br /> !:*Jrv_�------=­_. CitycMaa� .... <br /> 95---�r 7rC <br /> 2- <br /> Addreis <br /> "_C C ----.License #��V( Phone <br /> bhtractor's Name ------ 2��------0 -------- ------------ ------ <br /> -Installafion.will serve- Residence Apartment House,E] Commercial :F­lTrailer Court ;EJ <br /> Motel M Other ---------- <br /> Number of <br /> Number:of living units:-- <br /> Number of bedrooms _,Z------Garbage Grinder ------------- Lot Size ____________________________________________ <br /> (Nater Public System and name ----------- -------------------------- <br /> -------------------------------------------------------------------- ------Private R <br /> Character of sail to-a depth of 3 feet. Sand'El Silt E] Clay E] Feat E] Sandy Loam <br /> ,W Clay Loam ] ' <br /> 2�ty <br /> - ------ -- -- <br /> a --- - --- pe -------- --- - --- <br /> -- <br /> Hardpan ❑ Ado'beff Fill"M' ie7n;l f yes, <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc: must be placed on reverse side.) <br /> NEW INSTALLATION- (No septic tank or seepage pit permitted if public sewer is available within 200 feetJ <br /> X Z --- Liquid Depth <br /> PACKAGE-TREATMENT [ ] SEPTIC TANK, Size ------- <br /> -------------I----- Material rNo. Compartments -------�­ <br /> Capacity Type ------ <br /> -- ---------Y <br /> Distance to nearest- 'Well -------( -------------------------Foundation- ---Z -0----------- Prop, Line ---6................ <br /> LEACHING LINE No. of Lines ------ ---------- Length of each line---------2_45�--------- Total Length ............... <br /> 'D' Box 12VC_k_� Depth Filter Material ...I-P-l" <br /> ------;�---- Type Filter Material -------------------- -------- ----------- <br /> Distance to nearest: Well -------- Foundation __.___/__n_________.. Property Line ----J---------- <br /> SEEPAGE PIT Depth -------------------- Diameter -------------- Number ----------------------------- Rock Filled Yes 'E] No C <br /> Water Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well -------------------- ------------------Foundation ------------.------- Prop. Line __,------.-------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------- ----------------------------------- Date -------------------------------_- ) 0 <br /> SepticTank (Specify Requirements) --------------------- -------------------------------------------------------------------------------------------------------------------- <br /> V <br /> Disposal Field (Specify Requirements) -------------------------------- ------------ ----------------------•----------- --;:_----------------------------- -------------- <br /> -------------- ------------------------ ----------------------------------------------------------------------------------------------- -------------------------------------------------------------------- <br />- - ------------------------ -------------------- -------—--------- ------ -----------w------------- -------------------------------------------------&----------------------- ___ <br /> (Draw existing and require.d addition on reverse side)- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulationt of the Son Joaquin local Health District. Home owner of <br /> licen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work.for which this permitis,issued, I shall not employ any person in such mannef <br /> as to become subject to War n's. Compensdoon laws of California." <br /> ----------------------- Owner <br /> By ...... Tifle <br /> Signed 12� - --- ---------- ---- -- <br /> ---------- -------- <br /> if other n owner) <br /> FO I DEPARTMENT USE ONLY <br /> ---------------- <br /> APPLICATION ACCEPTED. BY __/--------------- ------------------------ --------------------- DATE 7 ---------- <br /> BUILDING PERMIT ISSUED --------------------------------------- --------------•--------------DATEDATE ------------- ---------------------------- <br /> ADDITIONALCOMMENTS -----:'-,°-=---=------------------- -------------------------------------- ------------It---------------------------------------- ---------- ------------ <br /> • <br /> ---------------------------------------------- ---- ------------------------------------------- --4----- ----------- ------------- --AW------------------------- ------------------------ ------------ <br /> ----------------------------------------- ------------------------------------------ -------------------------------------------- - - ---------------------------------- -------I---- --------------- <br /> -----------------------------------------r.- --------------------------------------------------------------------------------7 ------ <br /> ----------- <br /> Final Inspection by: ------- Date -- --------------------------------------- <br /> - - ------ ----------------- ---------------------------------- --------- Date <br /> LOCAL HEALTH DISTRICT <br /> E. H. 9. 1 1'.68.Re' <br />