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V FOR OFFICE USE: <br /> - APPLICATION FOR SANITATION'PERMIT <br /> -----------i <br /> ----------- --------------- <br /> (Complete in Triplicate) Permit No. <br /> ---------- ---------------------------------- <br /> ----------------------------- -----------:--------------- This Permit:Expires 1 Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This-,application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations. <br /> JOB ADDRESSA ATION, ------- ------ --------I------ ---- -------- -- ------ <br /> CENSUS TRACT --------- ---------------- <br /> Owners Naline -------- -------------------------------------I <br /> --------------Phone -------------------- <br /> 1---------------- <br /> Address ------1------- -------- -------- ------------ city <br /> Contractor's Name <br /> ----------- ------ --i <br /> ---------- - -------------------;-------License # ----- Phone <br /> Nj I <br /> Installation Will DO'ci-�rtfme-n't'H6iis-iiE]'C-o m- mie-r-cia-l�]Trailei Court ❑ <br /> Motel []Other <br /> Number of living units:--.--/----- Number-of bedrooms —:__.Garbage Grinder Lot Size <br /> ----------- <br /> ----------------- <br /> Water Supply: Public System and name -------- --------- <br /> ---------------- -----------Private <br /> 4 ---- ---- - <br /> Character of.§6ii to a depth of 3 feet: Sand'ED] Sil clay t Sand L.oam -E] Clay Loam E] <br /> Sandy <br /> Hardpan [E] Adobe ;��ilfiMaterial If yes, type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side".)' <br /> NEWJNSTALLATION: <br /> — (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT SEPTIC TANK;'4' <br /> Size------ ---------- Liquid Depth --- Z2-------- <br /> Capacity Type -PZW--- Material_- <br /> - No. Compartments oma____.. <br /> Distance to nearest; Well ___-_______________________________Foundation - -------------------- Prop. Line ------I------------ <br /> LEACHING LINE No. of Lines ----)----------------- Length of each line----/&V ------- Total Length <br /> m ------------- - - --------------- <br /> I <br /> _B7o_X4_M___ tipe—rilte-r'Ma�e�i6.f--/Z-e;,4- - 6e-- I <br /> -------------- -Depth Filter ---- <br /> Distance'to nearest: Well -------7=--------- Foundation __4q_-t------------ Property Line <br /> ---------------- <br /> SEEPAGE PIT [1��. !f Depth ---;;;LAr-------- Diameter Number -------- <br /> ------- Rock Filled Yes P;---No C] <br /> --------- ------- <br /> Water Table Depth -------_�4---------------------------------Rock Size AL-K2-------------- <br /> bistance ito nearest.. Well -----------t�-----_-----------Foundation --------- Prop. LineZ;.-..-:.-,............ <br /> REPAIR/ADDITION'(Prev.iSanitation Permit# ------------------------------------------- ----------------- <br /> N _4 <br /> Septic Tank (SpecifyRequirements} <br /> irements) ------------------------------------------------------- t <br /> ---------- ----------------- ----------------------------.1,------------ -------------- <br /> ci Requirements} <br /> Disposal Field [Specify <br /> -----------7------------------------------------------------------------------------------------------------------------------------- <br /> ------------------------------- ---------------------------------------------------------------------------------------i <br /> --------------- -----------------------------------I- <br /> ----------------------- <br /> ---------------------------------- <br /> -------------------------------------------------------------------------------------- <br /> ----------------------------------------------------------------------------------- <br /> (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 Son Joaquin <br /> County Orclinances,,State Laws, and Rules and Regulations of the Son Joaquin Local Health District. Home owner or licen- <br /> sed agents signature Certifies the following: <br /> "I certify that in the•'performance of the work for which this permit is issued, I shall no i t employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed -------------- -------I-------- ------ ------------ --------------------------------------------- Owne <br /> By ----- ------------------- <br /> ktc ------------------ ----------------------- <br /> I rc: , <br /> -- ----wl�------------------------- Title <br /> (146, e�r, than owner) <br /> FOR DEPARTMENT--USE-ONLY; <br /> APPLICATION ACCE[;TED BY --- --- ---- ----V(1 <br /> / —-----------------------------------------i----- DATE --- ff <br /> - <br /> BUILDING PERMIT MUED ----------------------------------------------------- Sv <br /> ----------------------------------------------I-------DATE ----------------- <br /> ADDITIONAL COMMENTS - -------------------------------------------------------------------------- ----- <br /> i <br /> ---- 4 <br /> ----------------------- ------------------ ------------ <br /> 14 <br /> ---------------------------------- <br /> i------------------------------------------------------------------------------------I------- --------- --------------------------------------------------- <br /> ------------------------ --W-- - 7------------ <br /> . . .. ­ __—, —.—� — - __--- ... -. .-; w-------------------------------------------- ---------------------- <br /> -------------L------------------ -------- <br /> ---------- <br /> ------------------ ------------- -Date <br /> Final Inspection by: ------- <br /> A ------------------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT j <br /> 9 1-'6$ Rev. 5M H <br />