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rv4uk [7ffluE t,t5t: APPLICATION FOR SANITATION PERMIT <br /> .. L21 : ............ permit N4.. ........... ......... (Complete In Triplicate) .. <br /> .....+ ...................... <br />... ,. " This Permit Expires 1 Your From Date Issued Date Issued!� � <br /> ...... -- ...... 7-�-�6 <br /> Application Is hereby evade to the San Joaquin Local Health District for a permit to construct and Install the work herein <br /> described. This application is made In 2W.-comppl`ia�nce with County �Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESS/LOC TION ..1:2-,.f d.I'a.. .S. . ........ .............................CENSUS TRAGI ...... <br /> Owner's Name .. ....... ......... ..... ................. .,. ...................................Phone <br /> Address ...1.. .._.�' C?. ..-• . . ��.�.------I.............City ..... ................ ..............6?... <br /> .�.. <br /> Contractor's Name .... s... '. ...-•--.....................................License # . . .. Phone : . . <br /> Installation will serve, once(]Apartment Hausa In Commercial[]Trailer Court 0 , <br /> Motel []Other <br /> Number of living units,............ Number of bedrooms ........--.-Garbage Grinder ............ Lot Size .................................... <br /> --.». <br /> Water Supply: Public System and'name ............•......................-----......._. __ .........................•........................Private u <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay Q Peat p Sandy Loam 0 day Loam [3 tJ <br /> Hardpan C] Adobe p Fill Material ........__..If yes,type-•............. ............ <br /> i <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATIONS (No septic tants or seepage pit.permitted if public sewer Is available within 200 feet,} # <br /> PACKAGE TREATMENT SEPTIC f ] <br /> TANK Site................................................ Liquid Depth ....................... <br /> Capacity.................... Type .................... Material...................... No. Compartments ............... <br /> Distance to nearest: Well .Foundation Prop. Line . <br /> LEACHING LINE No. of Lines length of each line............................ Total length ........................ <br /> _. <br /> 'D' Box :........... Type Filter Material Depth Filter Material ................. <br /> . , Distance'to nearest: Well ........ .............. Foundation ........................ Property Line ......... <br /> SEEPAGE PIT Depth Diameter Number ❑ <br /> t D p -;,-................ _.__......_..... _...........-----• ---.... Rock Filled Yes No <br /> Water Table Depth -------_----------------.....................Rock Size ................................. <br /> Distance,b nearest: Well ........................................Foundation ........-------• --- Prop.. Line .....---.-.-=--'- <br /> ---- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ........-•--.-•-----••............. ate ...................................I <br /> Septic Tank (Specify Requirements) ---•-•......... ._....---••-........ ...... . ....... ... ..................._.._. .......- -— ......... .... <br /> I <br /> Disposal Field (Specify Requirements) ..... -•- _ r..................................... ..:...... <br /> { <br /> ................................................................................. ....................................................................................... <br />�'• ..............................................................................................•---....... .......-----.-................._..__........... <br /> ..........,_._...............__.............. <br /> (Draw existing and requlred addition on reverse side) <br /> I hereby codify that I have.prepared this application and that the worts will he done In accordaim with San Jetagelrt <br /> I County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health District. Hence owner or.11can. <br /> sed agents signature tedifies the'following: <br /> "1 certify that in the performance of the work for which this permit is issued, I shalt not employ any person In such manner <br /> as to beco a subject to Wor man's Compensation laws of Califrno " <br />� Signed ... . - --• � .. ............................................. Owne <br /> By ................................................�.........................----.._...-••-•-•-------•---•. 31ttis .......-..........-.-...............-................................... <br /> (If other than owner) { <br /> FOR DEPARTMENT USE ONLY <br /> ., DATE '- <br /> APPLICATION ACCEPTED BY . .- .... ��....��.'.....�..� <br /> BUILDING PERMIT ISSUED ........:........... ......... ........................... DATE ........::.:. ........ <br /> ADDITIONAL COMMENTS ............................................. <br /> Av <br /> .......... __ ..._......... .... ...............................-... ...................--.....................I.......... ........ <br /> ..!..... ... ....-........ <br /> ................................. .�ins nspection y .... .. -.... ..................................... Date .. ....:z r .. ......EH 1.3 24 3-6f1 5AN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> J N <br />