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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 3 <br /> Permit No._7. --•------- <br /> ------------------ -- <br /> ----------------------------------- <br /> ------ ------------------ <br /> [Coriiplefe in-Triplicate) <br />,. --- ---- <br /> -- ------ -------- ------ ------------ This PIermit'Expires.1 Year from Date Issued Date Issued <br /> - <br /> ruct and <br /> l the work herein <br /> al <br /> ealth <br /> rict for a <br /> er <br /> made to the San comp <br /> Dian ecwitlh County Ordinance tNo <br /> Application is hereby mit to const <br /> . 549 and existing Rules#and Regulations. <br /> described. This application is made in P <br /> _CENSUS TRACT __-______________________ <br /> ------------ <br /> JOB ION ADDRESS/LOC T .___ /--�� s; <br /> �----�1�1n- - - ---- ------- ---- --- �--- - - ��p.Phone <br /> Owner's Name - - .. <br /> ---------------- City ---------------=_=-------- <br /> ----------------------- <br /> --------- <br /> ----------------- / Phone �o <br /> _kI <br /> 2 -_. :a v ---------•--- .License # 1-�?�C�� <br /> Contractor's Name - Zld_ - <br /> Installation will serve: <br /> Residence Apartment House ];Commercial :❑TraiierrCourt <br /> Motel ❑ Lot Size r-- ---•---- <br /> Other ----------------------------------- ------- <br /> Number of living units:________ Number of bedrooms -----/__.__Garbage Grinder - <br /> - -G+--- -��-`-�-- --- - <br /> ----,__-__private ❑ <br /> Water Supply: ublic Systemnd name -------------------------- --- Cla <br /> Sandy Loam [:1Y Loam 0❑ <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay ❑ Peat <br /> Hardpan ❑ Adobe k Fill Material ------------__- If yes, type ---------------------------- <br /> e placed on reverse side.) <br /> { <br /> PYot tan, showing size of lot, location of system in relation to wells, buildings,.etc. must b <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted-if public sewer is available within 200 feet, <br /> ' Size=� - i Liquid Depth :�:�----------------- <br /> PACKAGE TREATMENT [ ] SEPTIC TANK ( ] - <br /> Capacity Type Material---------------------=-`No."Compartments <br /> Distance to nearest: Well <br /> ` +` y _ <br /> - <br /> ----------Foundation -, ----------------- Prop. Line ---------- = ------ <br /> -- -- - h:------�--------------•-- <br /> LEACHING LINE ] No. of Lines ------------------------ Length of eacii6line__---------- ------ ------ Totai Lengt <br /> Z <br /> 'D' Box ------------ Type Filter Material --------------------Depth Filter Materia --------------------•------------------•---- <br /> Distance,to nearest: We _----------- ------- <br /> --- Foundation ------------------------ Property Line. ------------------•----- r <br /> Diameter --------- ------- Number ---------------------------- Rock Filled Yes ❑ No .0 <br /> SEEPAGE PIT [ ] Depth _------- -- - - <br /> Water Table Depth ------ ------ Rock Size ------------------------------ -------•----------------- - <br /> Distance to nearest: Well ---------------------------------- <br /> ------Foundation -------------------- Prop. Line ------ <br /> ' ----- -------- Date ----- ------ --------------------- <br /> REPAIRfADD1TlON(Prev. Sanitation Permit ------------ ----- <br /> ----- <br /> --------------------------- <br /> Se tic Tank (Specify Requirements) ----------------------------------------------------/---------------j <br /> P � <br /> ----=! ----- -- <br /> i Disposal Field {Specify Requirements} -----------------�----•----- - `'� " <br /> --- ---- - - <br /> - ----------------------- - <br /> ------------------------------- - <br /> (Draw existing and required addition on reverse s d e <br /> 1 hereby certify that I have prepared this application Regulations that <br /> of the San Joaquin Local D st�anHomece 'towner or leh Son e <br /> County Ordinances, State Laws, and Rules and <br /> sed agents signature certifies the following: <br /> "1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in such manner <br /> I as to become subject to Workman's Compensation taws of California." <br /> Signed----------------------------------------------- --- -- --------- - <br /> ----------------- - Owner <br /> ------------ <br /> -=------- - - -- - <br /> ------------- Title ._ <br /> (l# oth than own <br /> EP TMENT USE ONLY <br /> APPLICATION ACCEPTED BY ------- ---- ------------------------------------------------------------- --- <br /> DATE _ ,Z ' ---------- <br /> �------ -- DATE - --- ----------------------------- --•---- <br /> BUILDING PERMIT ISSUED -------- --- -- - - - -------------------------------------------------------------------- <br /> ADDITIONAL COMMENTS ------ --- <br /> ------------ <br /> ----- -------------------------- - <br /> ----- - -- ------------ ------- ---------------- ------- ------- ------- --- --- ------ ------ --pate---- --- ----- - -----k _____________________________________ _--______--_____ - �� - - -___ -------------- <br /> ------ <br /> �(1� <br /> Final Inspection by: -- --- ------- --- - <br /> ------------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6 Rev. 5M <br />