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FOR OFFICE use: AMICAWN FOR SANITATION PERMIT <br /> r T..... Permit No. . � ...S,S. <br /> ... ........................................... (Complete In Triplicate) <br /> issued �.7 <br /> This Permit Expires VYgar 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 <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .. .�&?yy.���� ....•... r�'� ... ............�:�-�c- <br /> .........................CENSUS TRACT ........................... <br /> Owner's Name ....................... <br /> --•-......... .................... ... ...... Phone . v��.....�.� ....... <br /> .. ............... ..........City . .� -----.... ... . ...... <br /> Address . - Q <br /> -.. <br /> Contractor's Name .. :� _ •• - ........................ ...:. --- --• <br /> ..•----.............,..-----license # ...- •-- Phone -- -.... <br /> Installation wil} serves esidence impartment House Commercial❑Troller Court ❑ <br /> Motel 0 Other.....•-..................................... <br /> Number of living units:__ ... . Number of bedrooms .,_....Garbage Grinder ............ Lot Size ••.•..-•...... ..... .....-- -•---•-• - <br /> Water Supply:{Public System and name • ------------------•-- •---._--------_-------•----.-•- ................................Private g <br /> Character of soil fo a depth of 3 feet: Sand b Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam E3 <br /> 1 Hardpan❑ Adobe❑ Fill Material ............If yes,type............... ............ <br /> (Plot plan, showing size of lot,-location of system In relo on to wells, bu'ildirigs,etc:mus#'T�e placed on reverse side.) <br /> NEW INS;AlLATIONt !�C a-septics tank or seepage pit permitted If .public sewer is available within 200 feet,) i <br /> e <br /> PACKAGE TREATMENT;-} ] SEAE TANKZype <br /> �Sixe..�....'......:...........•---.....--•---.....---. Liquid Depth �.......................� <br /> I ..,, Moterial.................. No. Compartments <br /> _, Calaacity��----°. -,�- ._4`__. � •--- � .��-..................- , <br /> f <br /> Distance to nearest 1flFeil � �l --f ` ......Foundation f� ...... Prop. Line0. ---.......�1 <br /> y .....# - ..._ <br /> LEACHING LINE o. of�Llnes •--•-• ;---••---. Length of each! line.............„_...�..f. Total Length .__........................_.3 <br /> 4V Box .�(:.__•....Type iFilter Material . r .-.Depth_Filter Material; �.:... :`: ..• • j <br /> I IV I <br /> T�3i`'s once to nearest:-Well .. Foundation ........................ Property Llw ......... ............. <br /> � 1 <br />? SEEPAGE PIT` [ ] Depth ..................... Diameter . Number .......... Rock filled Yes ❑ No <br /> Water Table Depth .. .. -.--"'...............Rack Size ................................ <br /> • .q , <br /> f N ' - <br /> " Prop. Line .. <br /> Distance b nearest: Well y ....Foundation .................. ---......-..-.---....� <br /> REPAIR/ADDITIONIPrev.Sanitation Permit ----.--• ......••-••--------------- Date ...........-•••••-••-•--•-•__..:.} <br /> Septic Tank}Spedfy-Requleernents)""-............- ---......�/ ...... ...�. ...................................................... <br /> Disposal„Fieia-(Specify_Requirrtments) .rS.. •°•-.... ........ ......... ...��, <br /> t' <br /> ........................................................: J�. .._� <br /> .................:�,�`` ............ !..... - .._ <br /> i 'v^l .. ............ .... ........ ..... .._.........___.._....... <br /> ...............A. . .X_. ..... .... .. ....... - <br /> if i (Draw existing and required addition on reverse side) <br /> I hereby sonify ithat 1.have prepared this application and that the work wilt be done In aceordanu with San Joaquin <br /> County Ord finances, State Laws, and Mules and Regulations of the San Joaquin Local Health District. Homs Owner or ITcen- <br /> i. sed agents,sign6ture certifies the following: <br /> ":I certify That In the performance of the work for which this permit is issued, I shall not employ any person In such manner <br /> 1 as to become subject to Workman' Compensation laws of Californla.” <br /> Signed . Owner <br /> .... �.. ... ...........•-•-----...................-----•-..........- Title - <br /> By ................ j -----... .................................... ............--------------........ ............... .......... <br /> i (If ether than owner} <br /> FODE}�AltfNiENT USE ONLY <br /> ... DATE ,. ....:.. '� <br /> APPLICATION ACCEPTED BY .. _ <br /> BUILDING PERMIT ISSUED ....._ :.DATE....... <br /> ADDITIONAL COMMENTS <br /> ........................ ................... •... .......................e.......................................................... ,......-. ........................................... <br /> . ............................... ............. <br /> Final inspection by: ...........Date ... ........ <br /> EH 13 24 1-68 flev. 51ol SAN JOAQUIN LOCAL HEALTH DISTRICT S/?!I 3M <br /> k <br /> j <br />