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uwm %rrrit-c mt: <br /> APPLICATION FOR SANITATION PERMIT <br /> :................:.... •-•-:._.._:.:_.._..:...: . — (Complete in Triplicate) Permit No. .. ..... <br /> This Pererrit Expires li Year Front Dolle Issued <br /> Date !:sued <br /> ............. <br /> Application is hereby made to the San Joaquin Local Health District for a permit to wnatruet and install the work heroin <br /> described. This application.is made in compliance with County Ordinance Permit it t and existing Rules and Regulations, <br /> he e <br /> k t <br /> JOB ADDRESS/LOCATION ... -S <br /> I Owner's Name .. .�... .. ............. .....CENSUS TRACT ....,....................... <br /> 1. <br /> Address , - /.._.-� . . ..... .` .......Phone ......... .......................... <br /> r <br /> T T -... .. <br /> .. City <br /> Contractor's Name <br /> . .:..`:...License # ,l c K3�........ Phone <br /> ..__.. <br /> Installation ...... <br /> will serve: Residence <br /> [Apartment House] Commercial❑Troller Court <br /> Motel ' <br /> ❑Other ........................... <br /> Number of living units..._: <br /> �.. Number of bedrooms3_...Garbage Grinder , <br /> ................. ��—....:... <br /> Wze ..... <br /> Water Supply. Public System and name <br /> -­=..................................................Private [ : <br /> Character of soil to a depth of 3 feet: Sand 0. Silt❑ Clay ❑ Peat❑ Sandy learn Ciay.Loam 0 <br /> lHardpan ❑ Adobe ❑ Fill Material ............ t6 yea,type ............... <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc, must be plated on reverse aide.) <br /> NEW INSTALLATION: (No septic tank or seepage <br /> � pit perms IfpblIc wavailable within 200 fee <br /> t,d <br /> PACKAGE TREATMENT SEPTICTANK <br /> Liquid Depth <br /> ...i.. <br /> ...........Capacity V_001'6 <br /> ..---._. { <br /> Type - Material...._. No. Compartments-- - ••• rt ants <br /> Distance.to nearest: Well /D Foundation 1 .. a" .,•.. <br /> ., Pro <br /> ._.._._... � p. Eine . <br /> LEACHING LINE <br /> [ No. of Lines .__...... ........... Length of each line.._...8..0.-.�.......... Total Length ... � ............. t <br /> 'D' Bax ..__.�f-__. Type Filter Material ....-;F&.. Depth Filter Material <br /> .... a .....-�.,lC...ter.................... <br /> ...... <br /> Distance to nearest: Well ..../�.Q.•�..-•.- Foundation � 5 ' <br /> SEEPAGIi P!T [ ] Depfih ....fes �...._... Property Line ......... N <br /> Diameter ................ Number .._...------------- .... Rock Filled Yes ❑ No <br /> - Water Table Depth - ...!tock Size <br /> ---•-- ......._... <br /> Distance to nearest: Well ................ _..._Foundation .. Prop. Line ' 1 <br /> REPAIR/ADDITION Prov. Sanitation Permit `` I <br /> . Date •••---•••. <br /> Septic Tank (Specify Requirerments]._--••-- _--_--- .................... <br /> ........................ <br /> Disposal Field (Specify Requirements! .. .................. <br /> ---- <br /> ••---••-• -------••-•----------•---•--•--- <br /> ------••---- <br /> (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 leaggitr <br /> County Ordinances, State Laws, and'Rules and Regulations of the San Jvaquln Local Health.Distrist. Name owner or litee- <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 /> as to become subject to Workman's Compensation laws of California." <br /> i <br /> Signed ---••-- ---------- --- <br /> --•- - - ---- -•-----..__._ Owner .t <br /> By ------------ ��- <br /> - <br /> (If other than owner) -------------------- Title .. <br /> DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> • - -�,_ --- ..... DATE ....:5.....'.,/ ..� <br /> BUILDING PERMIT`15SUED - ... ::ry_ - _ . . . <br /> ADDITIONAL COMMENTS -------•-.........!..._. . ------ ----..-DATE ......-... --- -•--.............. <br /> } ---------------•-----------------•------------ <br /> ------------------------------•--••------•-----------••--------•-----------------......_....... -----------_------- <br /> ---------------•---...-------------- ------------- -------- --- •---...................................... <br /> Final In <br /> Eli 13 2a 1-613 x. 5�1 .....---- •--••-•- •--- -- ................Date ... 5 �L.�',?. ............. <br /> SAN JOAQUIN LOCA! HEALTH DISTRICT 8/7$ 3M # <br /> e <br />