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... ... . ,,, t.. <br /> FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT 7 - S 6� <br /> (Complete In <br /> Triplicate) Permit No. .... ..:............. <br /> ........... <br /> .---••••. ....... _ <br /> ........... This Pen»itExpires 1 Year From Date.lssued Date Issued ................ . <br /> Application is hereby made to the Son 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 /> JOB ADDRESS/LOC TION ....... `...... .�.�. _. ._ ........................................CENSUS TRACT <br /> .._._ <br /> Owner's Name _ .,�_.._:_.. s,�...... �..... Phone <br /> ........... .. ............__................... <br /> . <br /> Address .._....� ...... �- �:....------ ------- .......City . . ........_<-._........................................................_ <br /> Contractor's Name ....___ .._�� ._ .. ......license # .� .. Phone .............................. <br /> Installation will serve: Residence Apartment Houseer"ercial OTrailer Court ❑ <br /> Motel ❑Other............................................ <br /> Number of living units:-------_-- Number of bedrooms ---------...Garbage Grinder .........,.. Lot Size ........................................ <br /> Water Supply: Public System and name ----------- ---•-- ....................................._........-..........................................Private ❑ d <br /> Character of soil to a de th of 3 feet: Sand Silt CoPeat Sand Loam Cla loam <br /> p ❑1 ❑` Y ❑ ❑ •......SandyLamY ❑ <br /> Hardpan L Adobe❑ Fill Material If yea,type............... ............ <br /> (Plot plan, showing.;size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.P) <br /> NEW INSTALLATION: (No septic tank or sge pit permitted if public sewer Is available within 200 feet,] <br /> PACKAGE TREATMENT [ ] SEPTIC TANK feep Size.. 1�._�.X. �............. .. liquid Depth .4 .................. <br /> --•- ., <br /> Capacity 1600 Type Material.rl .... No. Compartments .. ............. <br /> k <br /> Distance to nearest: Well _..__...--.�•,P.0... . ..........Foundation .....YP . --...... Prop. Line ....V _-_-- <br /> LEACHING LINE { No. of Lines _.____.--Y___._....._. Length of each line___-__-'/.he ....... Total Length ...1!�e?-�. ..... <br /> 'D' Box,.---/-:_-.. Type Filter Material ......5IC.......Depth .Filter Material <br /> ........................ <br /> ................. <br /> Distance to nearest: Well ...... �?. - Foundation ......11q� ...... Property Line .. ......... <br /> SEEPAGE PIT { Depth __ '_- Diameter � �.._... Number ..:.::....�............... Rock Filled Yea No C1 <br /> Water Fable Depth ..... ......................Rock Size ........... <br /> Distance to nearest: n.../X` :. Foundation -___ Prop. Llne ..,(_Va6 ...... <br /> REPAIR/ADDITION iPrev. Sanitation Permit# ' <br /> _._..--•----...._..--•--•--------------------Date ..................................) <br /> Septic Tank {Specify Requirements) ------------- ------- ........------_----------- --------...------ .....:...........................--............... <br /> .............. <br /> Disposal Field iSpecify Requirements) .................____............................... ............................................................I............... <br /> ----------------------­--- -------------------------------------------------- <br /> -_---------I----------------------------­ <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'lim accordance with San Joaquin' <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health.Dlstrict. Home owner or licen- <br /> sed agents signature certifies the following: , <br /> "I certify that in the performance of the work for which this permit is issued, i shall not employ any person In such manna <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed --••-------•-••--------•--•--------- •------------- ..- Owner . <br /> BY •--•-------...._ A%� _ ------. Title <br /> Ilf other than owner) <br /> _ FOR D Ei ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -- i3ATic .6' Z_r��_7__�._ ....__:..- <br /> BL11LDiNGPERMIT 155�lED --------- ...................--•-•.............. ............................_---•----... -------- -._DATE ------------•--............................ <br /> ADDITIONAL COMMENTS ------------ <br /> ---------- ------•--------------------•- ------..__..------------------ ----------...................... .....------.......-•--.-- ............. <br /> ..... <br /> Inspection b Date _.C 'Z �_ ..- .... -- <br /> P y: -------�.' --.. ._ .. <br /> EH <br /> �3 2t� J-1-68 Rev. 5M <br /> Final Ins SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />