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APPLICATION F09 SANITATION PERMIT <br />...................................................... <br /> (Complete in Triplicate) <br /> No. .. r. .° <br />._,..,_...........................................-...... this Permit Expires 1 Year From Dote lssuod <br /> Date Issued ....5 <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 application Is made in compliance with Counf Ordinance No. 549 and etclstlng Rules and Regulationik <br /> 1� `�s ' <br /> L-1 (JOB ADDRESS/LOCATION- ... cNsus taacr ...__ ............f <br /> d . . <br /> Owner's N/ . . 3 ..o..... ............................................ <br /> Address ..............-. <br /> Contractor's Name ........................................... <br /> .... <br /> . ............................... i. ..... ..License tit' ........................ Phone .............................. <br /> Installation will serve: Residence 6 Apartment House t7 Corrimercial ❑Traller Court t;] <br /> Motel❑Other .... E .......'......... ..... <br /> Number of living units:............ Number of bedrooms ......:.....GarbageF Grinder . ..... ... Lot Size .......................:..... .............. <br /> Water Supply: Public System and name .....................I.................................. ..I...............Private' ( . <br /> Character of soil to a depth of 3 feet: Sand❑ Sift❑ Clay ❑ Peat❑ Sandy Loam rj Clay Loam ❑ <br /> ." Hardpan❑ Adobe (7 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 iNSTALLAYION: (No septic tank or 5a page pit permitted If; bOh pwtfr is available within feet,} 1- / " <br /> PACKAGE TREATMENT ] SEPTI if j,e 1 ,............... Uqu1d Depilo ........... <br /> Capacity .......... Ty ................. Material...................... No. Compartments ...................... .. <br /> Distance to near: Well ....................................Poonc�i ................ Prop. Urns„7,V.. ..... <br /> l� . <br /> LEACHING LINE ( ] No. of Lin ........................ Length � 11W.&.._..._............... 'Total Len //.......................:.. <br /> •D' Sox .---•-----.. ..... . ._........ <br /> . Type Filter Material _ _ - Depth .Filter Material ........................................... <br /> } <br /> ',Distance to nearest: Well ........................ Foundation ........................ Property Line ..........................� <br /> SEEPAGE AIT [ j Depth Diameter ................. Number ............................ Rack Filled Yes ❑ No (] <br /> .Water Table Depth ........... ` ............ ` ...'..Rack Size ..................:............. <br /> Distance to nearest: Well ................. ... ..............Foundation .................F Prop. Line .................... , <br /> RkPAIR/ADDITION(Prev. Sanitation Permit* ............................................ <br /> ........ ...................'......... 1 Date:.`:�:::...:................. <br /> SepticWank (Specify Requirements) ........................••-----........... ..................................................................... ..................:..... <br /> DisposalField (Spactfy Requirements) --........ '.................................................................................................................... <br /> ......................................................... <br /> (Draw existing and required addition on reverse side) . <br /> I hereby cenify that 1 have prepared this applicallan`and that the work will be done In accordance with.San Joaquin k-. <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home Owner or-aim. <br /> sed agents signature certifies the following: L ' r . P I <br /> "I certify that in the pe ante "a work for which this permit is issued, i &hail not employ any person in such manner <br /> as to beco u lett t r a inpensation laws of California." <br /> Signe ............................................................... .......................... Owner <br /> By_-..-:........•-•--•...........................•------.........................:....---................ Title ........................................................................ <br /> (if other than owner) <br /> R TMENT USE ONLY <br /> APPLICATIONACCEPTED BY .................. ...: ........................................................................... DATE . ...... ................................: <br /> BUILDINGPERMIT ISSUED ................... ...............................:.................I................. . DATE .......................................... <br /> ADDITIONALCOMMENTS ...............................................................».............................................................I....................... <br /> .. <br /> .................. . ...................I........................................................................................ ................................................................. <br /> FinalInspection by: ..--•..............................................................................................................Date ... ........................................ <br /> EH 13 24 1-6(3 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT a/71I 3M � <br /> F <br />