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FOR OFFICE USE: <br /> nePLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) r <br /> ._....._. <br /> Permit No. .._T.....� .. <br /> ............................... ........ This Permit Expires ? Year from bate Issued Date Issued ..f - ;.,7 C <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 <br /> .2.... <br /> ._.l-�. ..- ';.3440...... ---------- - �0......_CENSUS TRACT Owner's Name ..--- .......................:......�.-----....... aneAddress . <br /> .... � . <br /> J,.....1. <br /> .........................•---•-.-...._._.. cit„ <br /> Contractor's Name ------- ) P�is.�- J _ ------..License # .------:-:..._ } <br /> -----•-•-- Phone -----••-•-•--------•----•:---- <br /> Installation will serve: Residence Apartment House] Commercial oTrailer Court 0 <br /> Motel []Other - <br /> Number of living units:___.-_-_ Number of bedrooms _.--T-----Garbage Grinder -,---------- Lot Size <br /> .............••--...._ <br /> Water Supply: Public System and name -------------------------•------•----•• ` <br /> ---------•------------------------- ----- •---•- Private ❑ i <br /> arocter of soil to a depth of 3 feet: Sand o Silt o Clay O Peat O Sandy Loom o Clay Loam <br /> Hardpan p <br /> . Adobe 0 Fill Material ............ If yes,type <br /> i <br /> (Plot pion, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW.INSTALLATION: (No se tic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [rPT#C TANK <br /> I l Size........................ <br /> ••-- --•--- Liquid Depth <br /> Capacity 1:4-0_0----.. TypedZtA4�0- ._ Material_. Gt,e No. Compartments _2 ....... <br /> Distance to nearest: Well ----- ......................Foundation ._ie--------- -- Prop. Line Z <br /> LEACHING LINE [ No. of tines _.-.7............... Length of each line.( .` C�4'v <br /> - _ ..-------�..-.__ Total Length ..-24v..Q.............. <br /> 'D' Boxoiltol -.._._ Type Filter Material-'�,4� Depth Filter Material .._._../ .`, C7 <br /> ...__. x <br /> Distance to nearest: Well J4�.............. Foundation _..!3 Property Line .. . . <br /> .................Q <br /> S.. f'1 Depth ._�!?............. Diameter Z_a'..!�-_.. Number ------/...................... Rock Filled Yes � .-. <br /> L7 X0.10 h <br /> � --� Water Table Depth .................... .Rock Size ---•-•-----•----------_-... -- _ <br /> Distance to nearest: Well ----------------------------------------Foundation .................... Prop. tine .................-•• I <br /> REPAIR/ADDITION(Prev. Sanitation Permit{# ............. •. ----------- ----- Date ................. <br /> Septic Tank (Specify Requirements) .............................................•................................... <br /> Disposal Field (Specify Requirements) ............... . <br /> ---------­---------- -------------------- -----------•--------•-- -•---- •• <br /> =--•------------ ----------------------•-•---------•---------•----------..........-----... <br /> (Draw existing and required 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 Regulations of the San Joaquin Local Health District. Home owner or Been` <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ an person In su <br /> as to become subject to Workman's Compensation laws of California." y p ch manner <br /> Signed - �._1. --------- <br /> Owner <br /> BY - --- Title ---..._. <br /> (if other than owner) -------------------- <br /> FOR <br /> ---------F R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------------- - 7� <br /> ------- ---... DATE <br /> BUILDING PERMIT ISSUED . <br /> ADDITIONAL COMMENTS ----------------- <br /> •-------• ---------------DATE ------ = : <br /> ...................... <br /> Final Insp ection by: • • _ <br /> ---- ................................................... • <br /> .---......---..... . <br /> ... .. . ... <br /> .. ....... / *• -•.-•-•---•-------•-•--•-------...._...__..------ --- <br /> .... <br /> Eli 13 2!t 1-68 Rev- 5M -------�.._.._.Date ..............�.��....--.---•-•--...._.._. <br /> SAN JOAQU#N LOCAL HEALTH DISTRICT $�7h 3M 1, <br />