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t <br /> FOR OFFICE USE: FOR OFFICE USE:" <br /> APPLICATION FOR SANITATION PERMIT <br /> --------------------------------------- ------------ (Complete in Triplicate) Permit`No.,_� �� <br /> ,_.V <br /> ............................t_�� <br /> • \ ------------ <br /> v` ,� Date Issued =,lQ <br /> ----•---•----------------------------------------------- This Permit Expires 1 Year From Date Issued <br /> Application is hereby made to,the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> ---------------------- <br /> �j +'� /j /ylLiU��iR <br /> JOB ADDRESSACCATI --- /---3 ...7-- ---------- / ---- CENSUS TRACT------- <br /> Owner's Name----------- ---- ---------- ---------------------------- -- ----------------------------- -----Phone-------------------------------------- <br /> -------- <br /> ------ <br /> Address -------- - :�.�.+ � ----- ------------ City - Zip <br /> Contractor's Name__*- 4l7h -- --- --- ------._--.--- -------- --- -•- _.__--License #_it (e ----Phoney <br /> installation will serve: Residen Apartment House ❑ Commercial ❑ Trailer' Court ❑ <br /> otel ❑ Other----------------------------------- - /9 G <br /> Number of living units:--- _._.......Number of bedrooms__ _Garbage Grinder---------._.LoeSize----------------- ------------------------------------- <br /> Water <br /> --_______ ___________ _-_--_Water Supply: Public System and name- -•---------- ------ ---- -------- ----------'---------- -------- ------------ - ----- -------------Private- _ <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ `Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam KV <br /> T <br /> Hardpan ❑ Adobe❑ Fill Material_---------If yes,type-------------------------------- <br /> (Plot <br /> --------------------- - -- -- -(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be=placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> --PACKAGE-TREAT4AENT -[- }:_ ...SEPT}C/T NIF-� } �..._, _ __a...�e- .��� ���--//� �/`2 <br /> >> u�{7id T7ptti <br /> Capacity-l_(�i fr!'O TYpe l�Gi rQN <br /> aria)--------------------------No. Compartments----- -- <br /> �-^ // � <br /> Distance to nearest: Well__ __�__/_---'__-________ ------Foundation. <br /> Prop,.Line_:C,, t!_ � <br /> 1f ------- <br /> LEACHING LINE [ ] No. of Lines_ 2f each line _, __,- __ Total Le�c----- <br /> 'D' Box----I- Tytttttp--9 Filter Material X� epth Filter Material____ --------------- __ <br /> �. <br /> Distance to nearest: le]l:- ____-. __ Foundcrlh =--- -----------Property Eine---, -_ <br /> SEEPAGE PIT [ ] Depth-- -- _-_ --_--Diameter--------------- ----Number----- --------.------- . ----- Rock Filled Yes ❑ f No❑ <br /> Water Table Depth_ --------------------------- ---------- Rock Size ----------------- ------- <br /> Distance to nearest WeIL__-___ ____ ________________________Foundation--------------------------Prop, Line,--._ ______ ------------- <br /> REPAIR/ <br /> _____ -. <br /> REPAIR,ADDITION (Prev. Sanitation Permit#------ -------------------------- --------- -----Date.---- --- ----_-=_- -------- 1 <br /> Septic Tank (Specify Requirements)----- -------- ----- -- --- --- ----------------- <br /> ,_ •---- -• <br /> irements) -- -• x ------ -------------- -•--------- <br /> Disposa1ex£fye�u -e-:- . ---- - -- <br /> ` <br /> ..-- -- ----- <br /> -------- <br /> ----- ------• ----------------------- - ---- t _+ ` w ---- ------- --•----- --------- •------- - ---- <br /> iad equired addition on reverse side)gi <br /> hereby certify that l have.p"oma d 4Wap*ftcAi*n a Aptithe work will be done in accordance with San 4fpaquin,County <br /> Ordinances, State Laws, and Rules,and Regu "'�gvhttttcat r Utensecli agents <br /> signature certifies the following: - ""'""� ` <br /> "I certify that in theperformance of the work for which this permit is;issued, 1 shall not employ any person in such memner as <br /> tobecome ubeO to <br /> -- ;. --ma ---_ Owner <br /> tans Compensation lovtrs of <br /> f, <br /> Signed ----- - ----------------------- ---------- <br /> BY .....' ��.. L ------ - .-- -----Title------- ------------------------------- <br /> (If other than owner) <br /> FOR DEPARTMENT USE LY' <br /> APPL4C#444N-AGC-EP-T - -BY -. _ - - -=. <br /> DIVISIONOF LAND NUMBER- - - ------- ---------------------------- ------ -------DATE ---------------------------------------------- <br /> ADDITIONAL COMMENTS----------- -- - -------- ------- _ ...... - <br /> Final Inspection by -------=------------------------------------------------Date <br /> E14 13 zaSAN JOAQUIN LOCAL HEALTH DISTRICT Fes 21677 REV.���a 3M <br />