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FOR OFFICE USE: <br /> ............. ...... <br /> ...-.---.----- APPLICATION FOR SANITATION PERMIT <br /> ..... 1Comploo,in Triplicate) ,..--��� <br /> .............---.......�:'3 a Permit No.!�?..`...4 <br /> .................... ................... <br /> This Permit Expires t Year From Deft Issued Date lssuod e-Z7-.?-.S� <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 /> Oh r <br /> JOB ADDRESS/LOCATICNV ....�y�.. .__.. c W au ,C� <br /> $ TRACT ........ <br /> Owner's Name ....�/.�'t-. ._l�✓./�:C_��.�j' <br /> Address . 3ZS' ... <br /> Phone .................................... <br /> ._... �.-�J� ... ........._..... t,, ....,..... <br /> N <br /> ..Ci ......._...... ................. <br /> Contractor's Name -------1 '" .....License --� <br /> a j ... <br /> /f Phone ?. ...G/14 <br /> Installation will serve: Residenceartment House 0 Commercial QTrollw Court �] <br /> Motel [j Other..... .............. <br /> Number of living units:-..,.... --- Number ofragms .-':;?::::Garbage Grinder �'' //�- <br /> // v <br /> .........-.. Lot Size <br /> .. . .......................... <br /> Water Supply: Public System and name _�1�...�_.�...� -• <br /> ...Private Q <br /> Character of soil to a depth of 3 feet: Sand'[] Silt 0 Clay ❑ Peat 0 Sandy Loam 0 Clay Loam ❑ <br /> Hardpan 0 Adobe iH Material if yos,typo <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on rover" slide.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) ' <br /> PACKAGE TREATMENT { ] SEPTIC TAMC J0 - v <br /> Yl. ........... ........ uld Depth <br /> Ucl ��°/., .......... <br /> Capaaty Type ... . ..... Material. No. Compartments ...�..,.:. <br /> ........J' <br /> Distance to nearest: Well em// Foundation . ... Prop. Lino ..�—� <br /> r'�---••----- <br /> LEACHING LINE .......... <br /> [tiy No. of Lines .....---f---•--- ..... length of each line... <br /> LEACHING <br /> Total length ... ©a .. 4' <br /> ... ........ .........D <br /> 'D' Box lv:pp... Type Filter Material ).;�Z4 , LDepth Filter Material fd©S <br /> Distance to nearest: We .. Foundation /a ` .. pro erty Li <br /> pne / ., <br /> SEEPAGE PIT j 13� ...... <br /> Depth ----a`S -�-... Diameter ..36..... Number ... ............. Rock Filled Yea [} <br /> Water Table Depth ...... <br /> .........................Rock Size ... <br /> Distance to nearest. Well ......elr/�.....................Foundation ...../?... Prop. Line ... ..l......... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .........................................................•-•---•----- Date .................................. <br /> Septic Tank (Specify Requirements) "................. <br /> Disposal Field (Specify Requirements) ...................... <br /> ---------------................................................ •--- --•• -- <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that l have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Hea1Hk©Istriet. Nome owner or Best- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for which this permit is Issued, 1 shall not employ any person In such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ......_..---•..............•_.. Owner <br /> By --------------- _ <br /> - ---- ........... _ Title <br /> (If o an owner) -._... ..... ............. <br /> FOR ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...... <br /> .. ...._..- ..-------. DATE . �. . <br /> BUILDING PERMIT ISSUED --------------- ------------ - ---- - ---------------------•----- - -- - -------.....- - <br /> ADDITIONAL COMMENTS ----- ATE - -------- •-----•...._....... <br /> .. '-- .1- .... _... <br /> ------ ................................. <br /> 9 ' �- , <br /> ... --- <br /> - ----------------------------------- -----------....... ---------- <br /> Final Inspection by: ..-. ............... ...... <br /> .• � -- --...-----... .--- --.................:..._..._.....---------- <br /> .........Date . . <br /> Fl;•I 13 2!� 1-613 Rey. 5�'i - --•. . .. .......... "- <br /> SAN JOAQUIN LOCAL H tTH DISTRICT $/7h 3M <br /> W� k <br />