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FOR OFFICE USE: <br /> ........I................. <br /> .APPLICATION FOR SANITATION PERMIT <br /> (Complete.in Triplicate) Permit No. -.7................ <br /> i This Permit Expires t Year From Date Issued Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> 7 <br /> egulations:7 . ° c_osc a.r-C r2-,0' � <br /> rz <br /> . XCENSUS TRACT ....0.f(-030.-02- <br /> JOB .ADDRESS/LOCATION ......... ............. r <br /> Owner's Name ............ate s+ ............ qe.4 � �.. . ............ Phone. � a� <br /> fAddress ............_.......� �il -. ...... . itY <br /> Contractor's Name ....11-V% 3`_... -_-_.�,, ..........License # ra Phone <br /> Installation will serve: Residence ❑Apartment House O Commercial:❑Trailer Court <br /> t -Motel []Other ,oWQV`.e --------, <br /> Number of living units:........... Number of bedrooms ..__._...._.Garbage Grinder M�-- Lot Size 4': /��y .._. ...... , <br /> •.. Private' <br /> Water Supply: Public System and name - _........ <br /> 4� <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt❑ Clay '❑'Peat' --Sandy Loafri'{]"`Clay'LO�m ❑ �W~ <br /> Hardpan E] Adobe❑' 'Fill Ma#trial-. If yes,type ::._-.:--- _-____ <br /> Ot <br /> (Plot plan, showing size of lot,,location of system in relation to welds, buildings, etc. must be placed on reverse side.)' <br /> t <br /> NEW INSTALLATION: {No septic tank or seepage pit permitted if"Public-sewer is available within 200 feet,).... <br /> PACKAGE TREATMENT SEPTIC TANKbg Siae/-$r {- Liquid Def t <br /> Capaci470--�? _ Type Materi o. Compartments„. ................ <br /> t3a <br /> .I fi . <br /> Distance to nearest: Well ....... ...........Foundation .. ---------- Prop. Lini-:,,f.............. <br /> [ ] No. of Lines -- - --------------- Length of each line...(*Ve_............. Total Leng#I ........... <br /> f� 'D' Box NF.- Type Filter Material 4e -Depth Filter Material40AWV <br /> Distance to nearest: Well .... ------ Foundation ....Z0............. 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(Prev. Sanitation!Permit# ) <br /> ------•-------------. .................... Date .................................. <br /> ISeptic Tank (Specify Requirements) ..................._....-------•-= ........................1....................................................- .---------------. -•----.... <br /> Disposal Field (Specify Requirements) .......-------------------------•-•--------------._.._�...... ............. ,:'f................---.....- .........•.............. <br /> •--------------------•-----•----------------------•- ............................------ -------- Z...... .............................._.--------------------------------------------- <br /> � l <br /> ....................................................................................................•..._.__ ._........_.._______-_V _.:.__:_--_._ ___-___.-__-_--_----.---_. _ _-__.-_ .._ _ <br /> -`" - "' (Draw existing and required addition on,reverse side) <br /> I hereby certify that I have prepared this application and that the"work 1wili be done"in accordance with San Joaquin <br /> I County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. home owner or licen- <br /> sed agents signature certifies the following: t ) <br /> I "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/Workan's Compensation laws of California." <br /> Signed ..--.-••-------------- .. OwnerBy c..:............•-.........._ ... ...-----.._...... title ..---.47 . ..(If othe ' �.""""y '- " . ' ; <br /> FOR DEPARTMENT USE ONLY <br /> u <br /> APPLICATION ACCEPTED BY Lt�)........ I.J £_ :----------------- --- ------------- y` ----...._ ....._. DATA~ _...= . 3 .................. <br /> F BUILDING PERMIT ISSUED ....... • - . <br /> � L ... . DAT.E. <br /> ........................................... <br /> ADDITIONAL COMMENTS --••• <br /> .........................................•-----•----•------------•----------...-•--•-••---- ........... .------. ................................ ................. •--............... <br /> ........................------------------..................... .............. .................................. <br /> ..----•-•-••---•---- --•-•............... ...- <br /> ........................... ....... . �„�. <br /> Final Inspection by: ..............Date ----- ......:• .... ................. <br /> .__... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT/ <br /> c u 13 24 t_•La n_., cu 7172 3 M <br />