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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ............................ .. ................. (Comply in Tri Ncatet Permit No. .,7 <br /> P .._- <br /> f� �.�...... Date Issued 6:7� <br /> ........ .. ...:..1. .................._..... .... This Permit Expires t Year fresh Doh Issiwd <br /> Application is hereby made to the San Joaquin local Health District for a permit to construd and install the worts herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ..-...... -- /./i/e../1/��..................................CENSUS TRACT .......................... <br /> Owner's Nameo%SCff_Fav............................ <br /> Address _. �y 7...... ...,. /��.�.. ./-�,Y c ....... . I City . '.. C l o..one.........................•--------- <br /> Contractor's Name /_..._l. .-•---- - ( or � . .�� <br /> 11►I ...SG. Ilf.�°t�.icense ...1.....�.�._._. Phone ro �.�� <br /> Installation will serve: Resldence�Apartment House{] Commercial j3Trailer Court 0 <br /> Motel ❑Other............................................ <br /> Number of living units------------- Number of bedrooms ...........Garbage Grinder ............ Lot Size ............................................ <br /> Water Supply: Public System and name ...•._... ................._............---....._................._.........................._......Private Q W <br /> Character of soil to a depth of 3 foot: Sand❑ Silt Q Clay Cj Peat❑ Sandy I oom ❑ Clay Loam <br /> Hardpan(3 Adobe E3 Fill Materlai............If yes,type............... ............ \�+! <br /> e® - Irll�p Ir1�4/IIw11���1w11��� AI��1� V <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 204 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK{ I Size................................................ Liquid Depth .......................... <br /> Capacity .................... Type .................... Mate rial...................... No. Compartments ...................... <br /> Distance to nearest: Well ....................................Foundation...................... Prop. Line ...................... <br /> LEACHING LINE [ j No. of Lines -.--_---_-----__-- Length of each line............................. Total Length -_------------7;;.... .. <br /> 'D' Box ...... ----- Type Filter Material ....................Depth Filter Material ............................................ <br /> Distance to nearest: Well ..... Foundation <br /> ................... ........................ Property Line ........................ <br /> SEEPAGE PIT [ i Depth .................... diameter ................ Number ............................ Rock Filled Yes Q No Q <br /> WaterTable Depth ................................................Rock Size ................................ <br /> Distance to nearest: Well ........................................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION IPrev. Sanitation Perms Date _ <br /> septic T nts) ...�-� _w..... .. .. % ;�� ..�.... ' . ..... /w. . <br /> Disposal F' Id (Specify Requirements) ._C4X <br /> ...... A! �,,-.. .......... <br /> L ...r/.... ........... JIB ...._�....................................................................•-•-•••-•--••....._........... .........._. <br /> ........................... -------- ------------------------------------------- ...........................-............................................................................................ <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work wiN be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son .Maquin Local Heahh:District. Heats "nor or Iicen- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit Is Issued, 1 shelf not employ any person in such manner <br /> as to b"ssubio Wor n's nsation laws of California.•, <br /> Signed <br /> 7----------------------------------- <br /> By <br /> -------------- ------ <br /> BY ---- ----•--- <br /> •..................... T:tle _...._........-.................................... -•--•-------••---•-• <br /> (If other than owner) <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY _ - - -- - . . ----- - -�.{ _.....__.... DATE ...._.�� .. .----- <br /> BUILDING PERMIT ISSUED :.-_ . . <br /> _. -_. .- -•--•..... ... . ..................... .__ ...... .... ----•-•---.-.._..-DATE - ---•`.._....._----...... ...........__ <br /> ADDITIONAL COMMENTS ... = --• . •. -----• ----------------------------------------------------_-------- <br /> -• - -- <br /> ....................... ........ ........ <br /> 0-�- - <br /> ... _;­�i-A,- -------------------------------------------- <br /> ........... ........... ------- ...... <br /> ­_.­ -- ------- <br /> _... ............I----­----- <br /> .......................... ...........• ..---- �. . . <br /> Final Inspection by ....._ . . .__ .— ------- -------------------•----------------_------.-........_Date ... . v `�.. ... .......... <br /> FSI 13 24 1-613 v. SAN JOAQUIN LOCAL HEALTH DISTRICT B/?)i 3M <br />