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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PPAIT 7�...... <br /> ............ .. :`. . .................... (Complete In Triplicates Formic No. ... <br /> ......................................................... This Permit Expires 1 Year From Date Issued <br /> 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 w th County Ordinance No. 549 and existing Rules and Regutationse <br /> JOB ADDRE /... '� .. .. <br /> SS/LTION <br /> .........,p �yT _ .. .......................................... . CENSUS TRACT ... .. ...... <br /> Owner's Narnq <br /> Address ..47.. ... . . ...... <br /> ... ......... .......................................a ................ ........... ...................•. <br /> Contractor's Name.� x.� .........................................................License # I A.-,F .2 Phone . 7. <br /> Installation will serves esidenoe Uj Apartment House[] Commercial❑Troller Court ❑ <br /> Motel❑Other............................................ <br /> Number of living units:............ Number of bedrooms —I....Garbage Grinder ............ Lot Site ...................................... . <br /> Water Supply: Public System and name •.............................._..............•............_.......---................................Private <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑ Sandy Loam❑ day Lawn❑ <br /> Hardpan❑ Adobe❑ Fill Material............If yes,type........................... ` <br /> (Piot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side. <br /> NEW iNSTALLATiONs (No septic tank or seepage pit permitted if public sewer is available within 200 feet,[ <br /> PACKAGE TREATMENT [ j SEPTIC TANK[ j Size ........................................... Liquid Depth .......................... <br /> Capacity 12,6 . Material...................... No. Compartments ��...'........... <br /> Distance to nearest: Well ....•.......•...........Foundation ...................... Prop. Line........... ......... <br /> LEACHING LINE [ j No. of Lines ..V.................. Length of each line.7e..r__.............. Total Length .24 ........ <br /> 'D' Box .L....... Type Filter Material ..`...Depth Filter Material ;449-"............................. <br /> • , Distance to nearests Well ........................ Foundation ........................ Property Line ................ . .. <br /> SEEPAGE PIT [ j Depth .................... Diameter ................ Number ............................ Rock Filled Yes ❑ No <br /> Water Table Depth ................................................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ......... <br /> REPAIR/ADDITION(Prov. Sanitation Permit# ............................................ Date ..................................I <br /> SepticTank (Specify Requirements) ........................................ .............................................................................................. <br /> Disposal Field (Specify Requirements) .......................................................................................................................... ...... <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 acconlema with San Joagvla <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District.Moate owner of Ili <br /> sed agents signature certifies the followings <br /> "i certify that in the performance of the work for which this permit is issued, I shall not employ any porton In 9*6 meaner <br /> as to becomy9 sub ect to rkman' Compensation laws of California." <br /> Signed ... .... .r .,.�........ :........................................................... Owner <br /> B ........... . . . ....................................... <br /> (If other than owner) <br /> 00,DEEP MENT 4i3 ONLY <br /> APPLICATION ACCEPTED BY DATE . .. ..'"–... <br /> `' <br /> BUILDING PERMIT ISSUED...................-W........................................... ........DATE <br /> ADDITIONAL COMMENTS ................................................................. <br /> .................................•--.......................................................---•--.........--••--....................................... .................................................. <br /> ................................................ . . ...... .................................... <br /> Final Inspection by ........... .............................Date .. ......... <br /> IDI 13 24 1-60 Rev. 5H AN JOAQUIN LOCAL HEALTH DISTRICT 6/7h 3M <br />