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k- <br /> ,` FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ' a <br /> ....... ............................ Permit No. ... t� <br /> 3 Sys (Complete in Triplicate) <br /> ... <br /> ..:............... ..................-.................. <br /> ) <br /> Date Issued ..*.-..._{.... . <br /> :............ This Permit Expires 1 Year From Date Issued <br /> alth <br /> rict for a <br /> ermit to construct and <br /> described Thislication is happlicationeiso the Sn Joaquin Local adetln compliance witheCounttytOrdinance No. 549 and existing Rulestanthe <br /> and <br /> JOB ADDRESS/LOCATION..,,) .e .:_�... est-: � ,. . :_��.. ....... .......CENSUS TRACT ....�..�................ <br /> Owner's Name . ? -�...... .............................................. Phone ..... ...... <br /> i Address ....... <br /> 3.a..�........ (.[ter! --- •------- City <br /> / �3 <br /> Contractor's Name ......... .fit.!�- .. / C: .............License # :.. 'hone .......................... <br /> j... R <br /> Installation will serve: Residence C] Apartm ommercial of-011 e..Court 0 <br /> Motel ❑ her .. <br /> Number of living units:............ Number of bedrooms ....___---__Garbage finest er ___..__-:-: Lot-Size _ <br /> Water Supply: Public System and name ............. .......................... .......................... ............... ............Private <br /> Character of soil to a depth of 3 feet: Sand E] . Silt❑ Clay E] Peat Sandy Loam I] Clay Loam <br /> i Hardpan ❑ Adobe ❑ Fill Material ..y'"- �If yes,type ...--------------__........__ <br /> (Plot plan, showing size of lot, location ofsystem in relation to wells, buildings, etc. must be placed on reverse s' <br /> NEW INSTALLATION: (No septic tank or-seepage .pit. permitted if public sewer is available within 204 feet,) <br /> PACKAGE TREATMENT [ J SEPTIC TANK�. Sixe.gI. .... .1.� ---`..X..... - ------ Liquid Depth ._ :.-----.---•- <br /> o , ` 7 s <br /> l Capacity ,2- PIA.9.0 Type .� rye. . Moterial._e-e4NO.- Compartments ... ............... <br /> Distance to nearest: Well .........4i /.-t............Foundation'... ..... Prop. Line ... .---_.--• <br /> # LEACHING LINE [� No. of Lines ....... ................ Length of each line--------�. j�! �- Total Length - <br /> r •• <br /> 'D' Box .... Type Filter Material ..5-A........Depth Filter Material .................................... <br /> Distance to nearest: Well ......5-a-�:�`--. Fovndation`..:._�:.�t :=--.=-1?r'operty Line __S_ <br /> SEEPAGE PIT [ ] Depth ____________________ Diameter ................ Number ____....-_.._.._...-'r....... Rock Filled Yes ❑ No 0 <br /> Water Table Depth <br /> Rock Size ...................... <br /> ----. ----------- ................... <br /> E Distance to nearest: Well ........................................Foundation .........--- -....! Prop. Line -------------------- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# <br /> f ............................................ Date ......................_..---.......A .. � <br /> t Septic Tank (Specify Requirements) ---... ............................................................. ---•-•---•---•-•-----------•------•----•-- <br /> } <br /> S Disposal Field (Specify Requirements) ..............•--•------•. --------- ----------------------------- ......... -------------------- ........ ---------- <br /> ----------- <br /> --------. <br /> ----------------------------------------- ---------------------------------------------------------------------------------------------------------- .................................... <br /> jDraw <br /> -------------------------------• --------- <br /> (Draw existing and required addition on reverse side) <br /> 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaqui <br /> County Ordinances, Stene Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licew <br /> sed agents signature certifies the following: jt <br /> ?r "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 /> as to become subject to Workman's Compensation laws of California." <br /> Signed ----------------------------------- Owner <br /> t -1 By ........................................ �!Z�.... .G ---------•---..... Title .. . _.._...__..._........._...---...-------._..... ................ <br /> (If other than owner) <br /> l FOR DEPARTMENT USE ONLY <br /> � APPLICATION ACCEPTED BY ._ .._.._-.. _ ........................... DATE ....... ............................. <br /> BUILDINGPERMIT ISSUED --------------------------------------.............----------:..............................,..............DATE .......------•---.._.......-------- ._.. . <br /> ADDITIONALCOMMENTS .......................•.. ...............------.................._--•--........-.......------....._...........-------------- ....:.............. <br /> F <br /> .........................................------- <br /> ..-. .................................. <br /> ... <br /> ..............................................I............... <br /> ..... .. .............--- <br /> •----•................................. .... ... --•-••-;•-----...----------._.._... ate ...__ .... ._. <br /> ..... .!� <br /> r Final Inspection by. _�. _ ......D ....... :_ <br /> t - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> i w 13 241--Ao D.- 4m 7/723 M <br />