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FOR OFFICE USE:. APPLICATION FOR. SANITATION PERMIT. <br />------------------------------------------ ------------- <br /> (Complete in Triplicate} Permit No: .__ �.... <br /> n .". -_.y- -_ _,. ..W-.... n_._-_-...__7_-___-,.. <br />..................... ................................. This Permit 1 Year From Date Issued <br /> Date Issued:./:;2,1,);74 <br /> ... <br /> Application s herr mode to the San Joaquin Local Health District for -- <br /> pp y q permit to construct and Install the work herein <br /> described. This application is made in compliance with County Ordinance No. 5.49 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION . .CGtkin. ._ 3_. <br /> ..... CENSUS TRACT <br /> �.r�. ..l'..... . .. _.e.:......... <br /> Owner's Name ......... ...... ...............,.... . ........ . ........Phone <br /> ........... 1 <br /> Address . . .. ... .... ....U.~. _. ��r .. 1.11._4_...__...... .. City ............ <br /> Contractor's Name ...................3-elT.......................................................License # .......I................ Phone .......................... -- <br /> Installation will serve: Residence P Apartment House f] Commercial OTroller Court 0 <br /> Motel ❑Other _.. -----­---------- <br /> Number-of living units------- .... Number of bedrooms ............Garbage Grinder ........:... lot Size ...rff!. !!!'.`......:................... <br /> Water Supply: Public System and name ....... ....................................._..................................................................Private <br /> Character of sail to a depth of 3 feet: Sand O Silt o Clay ❑ Peat f Sandy Loam Q. Clay loam ❑ <br /> Hardpan Q , Adobe.0 Fill Material ............ If yes,type............... ............ ' <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.' <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 208 feet,l i <br /> PACKAGE TREATMENT Jif <br /> ( ] SEPTIC TANK Size_----._._ ._ Q�- ---------------------- Liquid Depth -........ <br /> Capacity _10q_..... Type .................... Material.----------------..... No. Compartments ................ • <br /> Distance to nearest: Well ....................................Foundation .._. ................. Prop. Line ..........I...... <br /> ..._ <br /> LEACHING LINE No. of Lines .....------............. Length of each line.._..............._..__....... Total Length <br /> 'D' Box ......:----- Type Filter Material ....................Depth Filter Material ............................................ <br /> Distance to nearest: Wei) _...... Foundation Property :..... <br /> 6x5bF-.._..---- per#y Line . . . ... . _..... <br /> jp ...----. Mer ................ __-------.------Number .---......� Rock Filled Yes 7S No Q <br /> T <br /> Depth -----�..---• Dr <br /> � er Lef Water Table Depth _.. - ..............•-............Rock Size <br /> . I <br /> if Distance to nearest: Well -----.-> 0........:............Foundation ..... -./a-...... Prop. Line .. ............ <br /> REPAIR/ADbiTION(Prev. Sanitation Permit# ----------------------------------------- Date .......................:.::....... <br /> 1 <br /> SepticTank (Specify Requirements) r------------_------------- ---------------------------------------------------------------------------------------------------•------------ <br /> Disposal' Field (Specify Requirements) ...................._................................................ •---------._..... ................................................ <br /> .. <br /> ...........................------------.-----------------------------------------------------------------................._._______...._............_.___.........._.......__....._......_............_.. <br /> -----------------------_-------------------------------------------------------------------------.-_ ....................... ... _..__.........,_....__._._....._....... .............. <br /> (Draw existing and required addition on-reverse sidel j <br /> I hereby certify that f have prepared this aAplication and that the work will be done In accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules anti-Regulations of the San Joaquin Local Health,District. Home owner or licen- <br /> sed agents signatu certifies the follow; <br /> "I certify th t performan t . k for which this :permit is issued, I shall not employ any person in such manner <br /> as to t p tion laws of California;" <br /> Sign ..... -----•-• --- -- ------------- Owner <br /> By ----------------•-------- ------- Title <br /> (If other than owners 3 <br /> FOR D I ARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ----..._ ------ - •--- ::- _--•--- • - A.DATE l a. ../..O <br /> BUILDING-.PERM1T'iSSIJED'. -------------------- <br /> ---------------- - ------- -=------ ..._...-------------------------------DATE . . ------------- ........................ <br /> ADDITIONAL COMMENTS ----- -....- _. <br /> .-----•----------------------------------- ----------------------- <br /> ZQ�UI'N <br /> ---------- •-----...._-.....-.- •------------._.-..-_..-..--.--.--------------._._..__....------.....-----.--- <br /> . -------------• -•---- ----------------- x._.._.• /. <br /> Final inspection by /te _.. ...- ^ ...........:......•-----•- ----.Date .......J./.. 7� ........ . <br /> 13 2!t i SAN JO LOCAL HEALTH DISTRICT / 8/7h 3N <br />