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FOR OFFICE USE:.............[­ <br /> APPLICATION FOR SANITATION PERMIT <br /> [Cornpiete In Triplicate} <br /> Permit No <br /> .........�.............:.........•............. ...:..1:.. This Permit Expires 1 Year From Date issued a slued e <br /> :. Date •�j•S•7� <br /> ! F <br /> Application is hereby model to the San-Joaquin Local Health District for a' permit to construct and Install the work herein <br /> described. This application s made In compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> Y II� ' <br /> JOB ADDRESS/LOCATION .1 .........:...............CENSUS TRACT .......................... <br /> Y <br /> Owner's Name , <br /> :.-. '� <br /> d <br /> Address .................... � 5.�. ....... Phone :.. �'�tf. .._ <br /> ....... . ........ city <br /> .............................................. <br /> Contractor's'Name .. """"' <br /> .. <br /> .- ----••-�/lhls�*+ !.?;Ka.. c........License <br /> # ........................ Phone <br />' Installation will serve: Residence 19tApartment House Commercial❑Trailer Court ❑ ' <br /> Motel (]Other---------------- = <br /> 3 <br /> Number of living units:...-.. _ Number of bedrooms--� Garbage Grinder sized'T, <br /> W_=,e `S <br /> • .:....-----• g •-•......... Lot Size _......�............. <br /> Water Supply: Public Systema and name ......................._.........--- ........................... <br /> ....:.....................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Gay Loam <br /> Hardpan 0 Adobe Fill Material <br /> ® If yea, type ...................... <br /> Mot pion; showing size of i at, location of system' In relation to,wells, buildings, etc. must be placed on reverse aide.} <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 208 feet] <br /> PACKAGE TREATMENT. 1 ] SEPTIC TANK <br /> ] ] Size....................................=............. Liquid _Depth s <br /> a <br /> Capacity :_....-..... Ype --•-•-......-•---_ . Materl o .. <br /> al...................... N . Compartments <br /> . �� y art nts <br /> ` Dis# nce to nearest: WellFoundation - - <br /> F h ........ .................... <br /> LEACHING LINE [ ] Prop. Line ............. <br /> l No.4 f Lines _ -'.- Length of each line.. _ .................. Total Length ........................................ <br /> D'.;B..0 ............ Type Filter Material ...........Depth Filter Ma ........ <br /> a.T,..,. " . f ..:$... Material <br /> Distance to nearest: Well <br /> l j� ............. ....:..r.;Foundation .._....... ............. Property Line ................. <br /> SEEPAGE PIT [ j Depth 1 ...... Diameter ...... <br /> :....... Number <br /> : ,i ..... <br /> Rock Filled. Yea ❑ Na <br /> C 3 <br /> Wates Table Depth .. <br /> �..................... OC Size i�ze ...._ <br /> Distance to nearest: Well t <br /> � •...................• `� -•-----....:..Foundation ..................... Prop. Line ..... J <br /> REPAIR/ADDITION[Prev. Sanithtion Permit* .........................,r � <br /> Date -•} <br /> 3 Septic Tank (Specify Requirements} ......... t.S�4AV-�...- ..... <br /> E .................................................... <br /> Disposal Fie) (Specify Requirements) Q�+ 1. ,Q,AjX ...................... <br /> �r-__• <br /> ----dox........... I� r"( .�i_ ...�, 19�1e1 C..... . ._.. -� -....._.,. <br /> I <br /> -•--....--"•----•................................... .............. <br /> I 1� (Draw 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 Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health District. Home owner or licen. <br /> sed agents signature certifies the following: <br /> "I certify that in the performaAce. of the work for which this permit.is issued I shall not employ an ; <br /> f P P y y Person In such manner <br /> as to beynme subjeµ Work fan's Caoensation laws.of California." t <br /> Signed t 14.l.itl.trl9t. -- a- : <br /> BY .. ... .......:...... 7- . title � <br /> .� <br /> F <br /> (if other than owner( . .............. � <br /> EPARTMENt USE ONLY I <br /> APPLICATION ACCEPTED BY..J......: _ E <br /> • ................. DATE <br /> BUILDING PERMIT ISSUED .....��:... . :.:. ....I................•-•---.... r I <br /> . . . .,...-•------------ -------•--•• ----..:.......-_.._- . .......DATE ............... . ` <br /> ADDITIONAL COMMENTS �1. f `... i <br /> ----------------•-------........_.. <br /> ................................... <br /> ....................:...... ..... r <br /> Fina.1nspection by: ..... .�. ' ...... .............................•--------................................_........--- ....... <br /> ..................... <br /> ......................- Date ... ._.ir/... <br /> ............. <br /> SW JOAQUIN LOCAL HEALTH DISTRICT <br /> u 13 24�.•� n� _.. - <br /> ti <br />