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i <br /> R 02FICE USE: n APPLICATION FOR SANITATION PERMIT � <br /> I/ Permit No. ..� •7 <br /> .. ................................�._....---..... '(complete in Triplicate) <br /> Date Issued .. ...C._y <br /> This Permit Expires IlYear From Date issued <br /> l the work herein <br /> it to constr <br /> Application is hereby rnadeitso the <br /> eompliancein c with County al Health District diria a Na.n5a9 and ex sti g Rulestand Regulations: <br /> described. This application <br /> rr <br /> i;�.w <br /> JOB ADDRESS/LOCATION Phone ` ��� -- <br /> _........CENSUS TRA <br /> Owner's Name ,...... .. :. ... <br /> y <br /> Address ..... ....... . <br /> ...�r�_�7.�- .--- --- •� City ��:r !! <br /> ....... f <br /> - • -.License # phone <br /> (� t `u :Lice <br /> Contractor's Name ............ <br /> .F <br /> Installation will serve: �` ` Residence X-Apartm6nt�H-ou�0 Commercial []Trailer Court ] <br /> a n Motel ❑Other --•.........:............ � <br /> g ^�1 <br /> Lot Size...� _.. _.. �... j <br /> Number of living units::__;-.___;;, Number of bedrooms ........Garbage Grinder ..__ ❑ i <br /> • ��°' _..:....: .................Private <br /> Water Supply: Public System and name .._..............4---.----- <br /> ' h Peat Sand -Exam ] 'Clay Loam 0 <br /> Character of soil to a depth of 3 feet: :Sand❑. .Silt❑ -Clay ❑ ❑ Y <br /> Hardpan ❑ Adobe Fill Material =-•----- --. if.yes,fiYPe �---•-------- c <br /> buiidirigs,etc -must fie placed on reverse side.) <br /> (Plot plan, showing size of lot, location of. sysfierxi-..In relation to wells, t <br /> NEW INSTALLATION: :(No septic tank,or seepage;pit permitted if public sewer is available within 204 feet,} ; <br /> -- <br /> i f R ' a Size.......... ------•-•--------- Liquid Depth ............. <br /> PACKAGE TREATMENT [ I'S TANK <br /> _ .. ......._. J <br /> ..... Material...............•-••-_. No. Comport <br /> , <br /> GapacitY •-------••--........ Type --------------- 6 <br /> 4`v ..................... <br /> Foundation ------------------•- Prop. Line . <br /> `Distance.to nearest: Well .................... .....••-�•--.. j <br /> I . <br /> r <br /> LEACHING LINE [ j iNo. of Lines --- Length of e&h'line.---- •--.....-• Total Length .. <br /> — �..S... <br /> . .. Depth Filter Materia! .......---•-•--•-•-....------ N . <br /> D' Box ..._..._.'.. Type Filter Materia .....---••-•••--• - <br /> Foundation ............. Property Line ...............:........ <br /> ',Distance to nearest: Well ................... --- <br /> t iRock�Fjled- it es ❑ No <br /> SEEPAGE PIT Depth ❑ P <br /> - ---""• -rt` -Diameter-:_Y.:::•__::.., Number--.:..•:.__-•------•--- -. Y <br /> jl ,Water Table:'Depth ..............--•-•---........... A .........Rock Size ........................ <br /> { <br /> • j. r .t Distance t ta-Zi earestf: Well'.'....... .... <br /> ell'.'..•.-••----• .............Foundation .,.-----•-•--/----•• rap' Line` . -_�------------�--- <br /> '1 <br /> L <br /> REPAIR/ADDITION(Pirev, Sanitation Permit# ' Date _­--------------- <br /> Septic <br /> - --•----Se tic Tank (Specify Requirements . -------•-- �•-•- <br /> Disposal Field {Specify Requirements) ...,1 _X-3 M. <br /> fsi <br /> u ,_ .. <br /> ------•--•-•-- •••...... <br /> . - <br /> ------ <br /> --------•-•-------. ------------------ <br /> -•---`-----•----•---------. -- o(Draw existing and required additin on reverse;side) <br /> :►� r t <br /> I hereby certifyi�that I have prepared this application and that the work will be dans in accordance with San Joaquin <br /> _Rules and Regulations of the Son Joaquin Local Health District. Home own <br /> County Ordinances, State taws, ander ar Ilcen- <br /> sed agents signature certiFies4the following: i <br /> 1 certify that in the performance of the work for which this permit is issued, 1 shall not employ any parson in such manner <br /> to become subject to Workman's Compensation laws of California-" r € <br /> Signed -------------- ---•- :. Owner <br /> l <br /> Title <br /> By s <br /> (If other th ner) .- <br /> FOR DEPARTmENT USE ONLY <br /> � ----•-•-----••..................... DATE ._...�.`--'.1•rd-..`'��-...... <br /> APPLICATION ACCEPTED Y .._...- ,6 -. <br /> DATE ._... <br /> BUILDING PERMIT ISSUED :" <br /> ..----....._ <br /> ADDITIONAL CO MENT .. •-----••...:_ --•.......:............. .................. <br /> ... :: :.. . �= :- ....................................... ...... ..._...__.....--- <br /> ..--------••-•. ...-----•-• ---•- <br /> -- . . ........Date ....?�. ........ .._.... <br /> Final inspection by: '.....:..:...............:...•----...-•---...------......---- <br /> �,. <br /> . LOCAL HEALTH DISTRICTSAN.JOAQUIN <br /> � 7172 3'M <br />