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--- PO •OfF10E 6SE, <br /> APPLICATION FOR SANITATION PERMIT Permit No. .s?: <br />..................................................... (Complete In Triplicate} <br /> .................................................... Date Issued <br /> This Permit Expires I Year From Date Issued �-- <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 ap i ti s/ride compliance with County,Ordinance No. 549 and existing Rules and Regulations, <br /> •, i r ....., �k..... ,•....... <br /> T ......CENSUS TRACT .......................... <br /> p. i . <br /> JOB ADDftESi/L AT ' <br /> .Phone ................................. , <br /> Owner's Name .........+ tai .... ................................. ...... a.\., ...... <br /> Address ............. �� . ._.. .. . I" E.rr ..__...................... al ...........:..........L.�........................ <br /> ill: :� .......1. 2.✓►�37:.. ... .......iicense ... Phone <br /> Contractor's Name .... ......... •. i <br /> Installation will serves Residence O Apartment.Hause❑ Commercial❑Trailer Court C] i <br /> Motel❑Other_2 .....s............................... . ...d'. r .......... <br /> -•-• <br /> Number of living units. ...-.-1 - Number of bedrooms I :­Garbage Grinder ...:::.... Lot Size <br /> t .Private gJ <br /> Water Supply Public System and name ------------------ - .. ----......................................... <br /> Character of soil to a depth of 3 feet .i Sand❑ Silt❑ Clay ❑ Peat❑ , Sandy'Loam 0 day Loam ❑ � <br /> Hardpan$3 Adobe.-E] Fill Material . .........If yes,type............... ............ <br /> {Plat plan, showing size of lot, location of system In r;fatlon W wells, buildings, etc. must be placed on reverse side:.~ <br /> NEW INSTALLATIONS (No septic tank or seepage pit permitted if pu fic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK€ ) Size.. . ra4,1,C _ Liquid Depth .......................... <br /> My 'i Y <br /> Capacity ..... .r�Type ! Material. No. Compartments ... ..�= .--... <br /> f� <br /> Distance' to nearest:yWelY ............ :Foundppation _ _ ......._....--- rap. Li .............. <br /> - - C* 1Q r /Total Length 7�.............. <br /> LEACHING LINE [ No. of Lines ...C-.......'`.....•length of.each Ilna.---. <br /> 'D' Box . : .: -- Type Filter AAater dl 7cc�-...Depth Filter Material � �.......: ...�....... <br /> Distance to nearesti Wei 1' r�_-Foundation _......ex ...... Property line .. .......... <br /> � __ � " ._...... ....__.... Rock Filled Yes ® No <br /> SEEPAGE PIT (;J T Depth ... ••---• _I Diameter ,, ......... Number <br /> Ak <br /> Water Table Depth ...................... .. ....--•-•---•- .Rock Size <br /> E ` Distance b nearest:Well ----. d.� �-....•..._..... .foundation . i �.......... Prop. Line . `• ............ <br /> Y <br /> .. <br /> i <br /> REPAIR/ADDITION IPrev. Sanitation Permit ...............••---•••-••__........__-•.. Data -----......_.:........._......_..}. <br /> Septic Tank (Specify Requirerneotsf......................................... - •--....._.........................-----••---.......:....�. ,....._...._................ <br /> .......... ......•-•--......:-........I.......... <br /> Disposal Field (Specify Requireiments) ............................................ ....... <br /> ..........•---............--__.... _;. .--- . . . ......................................................................................#..................... <br /> ................... <br /> ........... - <br /> .......... ...............•.._..........---_.__...I........................�-` `........ -......_._..........__... <br /> ..... ......•-- <br /> ..........__....i... -•--- <br /> IDrow existingand required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the worts will be done In accordance with San Joaquin <br /> County Ordinances, Stats Laws, andIRules and .Regulations of the San Joaquin Local Health District. Nome ewnef Of Ilten- <br /> sed agents signature certifies the%1166 Ing: <br /> t' "i certify that to the performance of the wont for which this permit is issued, t shall not employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California. <br /> Signed ._.... . ..... ......... .... Owner a <br /> 8y .......... 1�:] <br /> .�.�.•.•....-•.... .---......._.... ....------ •--•-••. -- ... 71tle <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ............ ..... ...... <br /> �......... DATE .....v-.f--1�4..' .: ............. <br /> . <br /> BUILDING PERMIT ISSUED DATE ........... ... <br /> ._- .......__.. _.. ..................•......... .................. <br /> ADDITIONAL COMMENTS .. <br /> .................................................. '•- ..............._....--_• ...... ... . ............................ ....._.._......_..: .... <br /> _ ...................................:....................................I......._....... ..... ............... <br /> .... ......Date . <br /> Final Inspection by: <br /> EH 13 2!i 1-0 S 'N AOUIN LOCAL HEALTH DISTRICT 8/7 3M <br /> r' <br />