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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT <br /> lComplete In Triplicate! Permit Na. ...GG................ <br /> { <br /> ......................................................... <br /> ...... .:..... .... :..................... . This Perr�lt Expires t year From Data IssuedDate Issued^.4.` <br /> Application Is hereby made to the San Joaquin local Health Distri for a permit to construct and install the work heroin <br /> described, this application is made I n with C d ty 04dinance No. 544 and existing Rules and Regulations: <br /> ,JOB ADDRESS/!O ON . �' ....Z q...: ., <br /> ......................CENSUS TRACT .......... ... <br /> Owner's Name t�. ................ .......... ............... ..Phone .............................. <br /> Address ...,..... ,.... 22. City . ....... f :............ ..>,n <br /> Contractor's Name ...........,. .................License .J . .l.� phone , :. <br /> Installation will serve: Iles Bence Q Apartment House 13 Commercial OTroller Court [3 <br /> Mote!❑Other . <br /> ....................... ................. <br /> Number of living units:...'. Number of bedrooms .fir_....Garb a Grinder ............ Lot Slks "............:..:...........:......... ...:.: <br /> Water Supply: Public System and name . ..:G ! ..... ., h�`' :............................................Priv <br /> Character of toil to a depth of 3 feet: Sand Q Silt❑ Clay Q Peat Q" Sandy Loam 0 Clay Loam Q <br /> Hardpan Q Adobe 0 Fill Material ... ........1f yes,tyles... <br /> ............ ............ <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATIONe (No septic tank or seepage pit permitted If public sewer is available within 200 fact,) F <br /> PACKAGE TREATMENT SEPTIC TANK ij �..... ............ Liquid Depth .....4............... <br /> Capacity ...C.�dE. F�,._ Type ...L� �.-.-x. ... Material. .............. No.- Compartments ..:.S.... ..d <br /> Distance.to nearest: Well .... . .......................... .Foundation . .?b-. .: .. Prop. Line .. ......I........ 6 <br /> LEACHING LINE { } No. of Lines .?.:.d��.............. Length of each line.......7.�? ......... Tota! Length ............6 <br /> V Sox .............. Type Filter Material .............. .Depth filter Material ................ . ...................... <br /> i Distance to nearests Well ........................ Foundation ........................ Property Line .....1�. ..............rn <br /> i <br /> � . SEEPAGE PIT Depth kxq--Xto Diameter ................ Number <br /> ........ .:.. .......... Rock Filled Yes Ck No q6 <br /> Water Fable Depth ................................................Rock Size . '. .... <br /> Distance to nearest. .........Weil .....I........•.........................Foundation ......... Prop. Line ...........•. <br /> 45PAIR/ADDITION(Prev. Sanitation Permit# ..-........... ........:........ Data ..... ................... � <br /> Septic Tank (Specify Requirements) ...... ......:... ...... ..............:..............:•----..............._........_............_.._............... <br /> Disposal Field (Specify Requirements) ............ _,........_:...........:...........:..._._:. <br /> is •....................... ................. ... <br /> ..................................................................---.....---......--•--•--...............------......................------..._...................:........................................ <br /> (Draw existing and required addition on reverse side) . <br /> 1 hereby certify that 1 have prepared this application and that the work milli be done in accordance with San Jeagein <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health,District.Home owner or Ilcon. <br /> sed agents signature certifies the following: <br /> "i certify that In the performance of the work for which this permit Is Issued, I shelf not employ any person In such manner <br /> as to become subject to Workman's Compe tion laws of California." <br /> Signed ............. .. .. . Owner <br /> ---- ...................... .................... .......... <br /> .-.. <br /> By ..... .... ..... .:....... .. :.......-...-- -- Title ........ <br /> If th r th now er) <br /> PQR"EFOPATMENT USE ONLY <br /> �s <br /> APPLICATION ACCEPTED BY ...--.... . '.fir. ........ .... .. --.. �:----:-..--....-.........:...-..........,,,.-..- . <br /> BUILDING-PERMIT ISSUED"......:. :.. DATE ..,....:..............:........... <br /> ADDITIONALCOMMENTS ..........................................• ------•..........._--........ ..................... ................................:........................... <br /> .................................................. ...........---------...----.....................---.........................-----.--.. ........•.... <br /> ....................... ..........-. .......................... <br /> Final Inspection,by: .....--..Ell .... = Date .... . .2,�.. <br /> Z3 21t 1-{EI 13�v. I AN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />