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' FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> 7S Ci <br /> Permit No. <br /> {Completi En Triplicate! 4 <br /> ............................................ This Permit Expires Year from Data IssuedY _ Date <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 applicotion is made In compl;onnccee wit ounty Ordinance No. 549 and existing Rules and Regulations, <br /> !OB ADDRESS/LOCATION W <br /> '� .. -� •..•... �. ... ! �NSUS TRACT <br /> rOwner's Name .., - .............................:................Phone ...........--..............I...... <br /> ,_ <br /> ......... ...City ...,. <br /> I 1 ........LcsContractor'tName .y� .Zhane <br /> Installation will terve: Residence Apartment H61ise C3 Commercial OTraller Court C] <br /> Motel p other. _...... ................. <br /> Number of living. unites-. .. .:. Number of bed ours .. . . ...Garbs a Orinclor ....... lot Size ... .......................... .. <br /> Water Supply, Public System_ and name . .. +.u�! .. .......ze ... .......................................Privote Q <br /> i „ <br /> Character of sail to a depth of 3 feats Sand 0. Slit Q Clay 0 Peat❑ Sandy Loam-Q <br /> Clay Loam <br /> : Hardpan fn Adobe 0 Fill Matsrtal . .... if V",VPS............... ............ <br /> (Plot plan, showing $lie of lot, location of system in relation to wells, buildings, etc, must be plated on ravens sides <br /> NEW INSTALLATIONS (No septic tants or seepage pit permitted If public sewer is available within 204 <br /> TREATMENT - J ] <br /> PAAGE SEFiC TAN <br /> K{ 3Size....t. .., .. .... ,. .?...... liquid Ckpth .. <br /> t Capacity i Type ...I Materlal.... ......... No, .Compartments .... . ........... <br /> Distance. to nearest; Well .................................... <br /> Foundatlon ...................... Pmp. Line .............:......: <br /> LEACHING'LINE ] No. of lines ...... ... Length of each line.._.. .............. Total length f. ............. <br /> 'Q . <br /> ' Box ...... Type Filter Material ....... .Depth .Filter Material ............................................. <br /> Distance to nearest= Well ........................ Foundation ............... .... Property Line ........................ <br /> SEEPAGE PIT ( ) Depth Mt.,X.10 Diameter .......... , Number ....., _ ..... Rock Filled Yes No !E <br /> Water Table Depth ....... .. ... ... ........... ...Rack Site .. •. <br /> t Distance to nearest: Well ........ ...•...... ....... ,Foundation . Prop. line .............. .. <br /> ROPAIR/ADDfTION(Prev. Sanitation Permit# ...... . .... :.........Date ............................... <br /> .. .} 6 <br /> * Septic Tank�(Specify Requirements). -------•-- ---.......-- -=- ........ . ..-•----...... ............... .............. <br /> , <br /> Disposal-Field (Specify Requirements) ............. <br /> .. -......--•-----...... ........ ...... --•....-._........... ....... —..........-........... ........�» <br /> •----......._....--------------------•--.._.--....-._-.............. ...-.. ._.............................. <br /> + IDraw 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 San �tgitin�� <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health:District. Home owner or liean•� <br /> sed agents signature certifies the following: <br /> ! "I certify that in the performance of the work for which this pen' nit Is Issued, i shall not snspioy any person in suds manner <br /> j as to become subject to Workman's Compensation laws of Callfanda." <br /> Signed <br /> � ......- ... ..----... .............. _...... Owner A <br /> By ................. ���.:.. !.. i .:... .Title .......................................:--..._...... .... ...... <br /> f other than owner) : <br /> FCR Di: ... RTMENT USE ONLY <br /> �....... <br /> APPLICATION ACCEPTED BY .,....... ....... .. rr:.-- ..-....._._...... ............................... DATE ........ ..Y- -7y.... ...... <br /> BUILDING PERMIT'ISSUED ...:........ .:....:..... ......... ..... ..........................................................DATE ....... ......._........... <br /> ADDITIONAL COMMENTS ........ / -.-..... .. ...... <br /> ................I....................... ........................ ......................-................-......... ......................................- ....... .... <br /> ................................................... ............... :.........-..--.-...-..,.........-.........................................�..... .................... <br /> .............................................................._-:. <br /> ........................................... . <br /> Final Inspection b ............. / �.......... �^--� ...-Date .......� ..7s'�............... <br /> EH 13 21; 1-68 Rev. 5m SAN JOAQUIN LOCAL HEALTH DISTRICT $/7h 3M <br />