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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Permit NO. .7"T- Sy <br /> ......."........_._. <br /> :............................ .. ... (complete in Triplicate) <br /> ............ <br /> ................ ." <br /> ..............." p <br /> Date Issued ... .`.y". Y <br /> 1............:...."....:.."......_..._..._...._..__...... <br /> This Permit Ex ires 1 Year From Date issued <br /> and <br /> l the work herein <br /> Applicatmit to construct <br /> ion is hereby made to the Say compliance <br /> � l+aLocal <br /> c cwitheCou ty O dinance or a NO. 544 and existing Rules tand Regulations. <br /> described. T appli ,6 y+ i�mode p r� <br /> !� ( QfJ f <br /> r <br /> .� � <br /> ..... �-. .;�................"..._..._-� ..... ENSUS TRAGI` <br /> JOB ADDRES /LOt I / <br /> _..`.'l _... ...._,} ............Phone .................................... <br /> "Owner's Name / ,.....1��. .._ _. <br /> _ _ <br /> /-" ........ city --�•-----. •.........:... <br /> Address . ..1� e.._. hone ' :.. <br /> License s. -�P <br /> Contractor's N e ._.._._._ /A�partment <br /> Installation will serve: Residence blouse❑ Commercial ❑Traiker Court ] <br /> f �. . <br /> Motel ❑Other -_._._ .._... <br /> _ I `�`� .. age G ' er _ Lot Size ..G --. --.... <br /> Number'of living units:....... Number a edrooms _..... ..... <br /> ......Private ❑ <br /> Water Supply: Public System and no s, and Loam ❑ Clay Loam ❑ <br /> `n <br /> I Character of soil to a depth of 3 feet: Sand'❑ Silt❑T Clay ❑ - -, v� <br /> Material��if yes,type Hardpan ❑ Adobe a -----------------------••--- <br /> be placed on reverse side.) <br /> {Plot plan, showing size-of lot, location of. system in relation to wells, buildings, etc. must f <br /> NEW INSTALLATION: (No septic tank or see age pit permitted..,if. ubl`c sewer is available within 200 feet,) <br /> Liquid Depth ...._. ... ..2— <br /> SEPTIC TANK Si e.. .._ ..- .............. <br /> .........:. <br /> PACKAGE TREATMENT ( ] <br /> o. Compartments <br /> ` jj ----- Material <br /> ... .....r��--• <br /> f 3 1 Capacity _."1.... " ..__.:.-- Type <br /> • � ... Pro Line -.- �...:.. <br /> I nce to nearest: Well ... -•-• Foundation . _... -•""-- p <br /> �r�. - c J.,_...... <br /> LEACHING LINE No. of Lines ..-" - Length of ch line."(,� s--- - ---•••- Total Length <br /> J 1i ' _ . <br /> ... ................ <br /> "U`e th Filter Material <br /> 'D' Box -: .Type Filter'Mat`erial . ... _ / <br /> d..l_..__...... Property Line Y................. <br /> istance o nearest: Well ....""�*�-.... Foundation _.. -• <br /> !l f" Rock Filled Yes l�1❑ <br /> J -_ Diameter .. 1�__. Number .__.--- •- <br /> SEEPAGE PIT Depth ...�"----- . <br /> Water Table Depth -- ....) ......: ...............Rock Size <br /> Distance fo nearest: Well <br /> ..._.......Foundation .1 •t .._ Prop. Line --•------•-•-- <br /> /� ---- <br /> ` <br /> --•,--- -" �" ------- Date _......... -•---.. .---- -1 <br /> REPAIR/ADDITION(Prey. Sanitation Permit ------------------------------------ <br /> Septic Tank (Specify Requirements) _--__:. •--••---•............................... <br /> f -............. <br /> Disposal Field (Specify Requirements) ................... .......................------------------------- <br /> d --------- ............. ---------- •---•-----------------•-"----••------ <br /> -----•-----------------• ------•-• ------ ............................. }. <br /> . ..................... <br /> __.----- <br /> ----------•• .... <br /> i • (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 in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Losal Health District. Hone owner or Ilton- <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 manner <br /> I as to become subiect to Workman's Compensation laws of California." il <br /> . �. Ow <br /> n <br /> e <br /> Signed -------•------------•--------------- -- kTitle <br /> --- <br /> ....-..._ ----- <br /> By ........ ._. <br /> {If other than neri E, <br /> FOR EPARTMENT USE ON . <br /> APPLICATION AC116 <br /> CEPTED BY .... .... <br /> DATE <br /> BUILDING PERMIT ISSUED ............•.."" .... ----.. <br /> ADDITIONAL COMMENTS <br /> .................... <br /> .."............ <br /> ......... <br /> •-------.... " ------...-----....-------• ------........------ <br /> ------------------------------------- --------------------------- -- ----- <br /> ----------------------- ...-._ ate <br /> ...........--•--....._....----. .. ._:......... .....__...Date .._ _ `� _.......... <br /> Final Inspection by: ...:............ .. ... <br /> .......•-------------------•- <br /> SAN JOAQUIN LOCAL' HEALTH DISTRICT <br /> r 7/ 311 <br />