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FOR OFFICE USE: <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT I :? <br /> Permit No.. . <br /> (Complete in Triplicate) <br /> Date Issued. <br /> This permit Expires 1 Year From Dote Issued -- <br /> Health <br /> Deshlicfor 0 permit to construct and instalthe ot5A9 a d exist ng Rules a d Regulatjon5 work herein descriheci. <br /> Application is hereby made to.the San Joaquin Local He l <br /> ir <br /> This application is made in compliance with County <br /> f <br /> ...CENSUS TRACT -- <br /> 9 " <br /> JOB ADDRESS/LOCA,TION Phone <br /> Owner's Nome <br /> _Zi <br /> 7 <br /> g�.� �.. ��� city . - - -- . .,... ". ... <br /> Address- .... .. . <br /> ............. <br /> .. ....:. .license Phone. <br /> Contractor's Name . .. ' <br /> Installation will serve: <br /> Residence Apartment Houser Commercial 1. Trailer Court k_1 <br /> Motel ❑ Other- .. _ -• " <br /> Number of living units:. L -------Number of bedrooms .. .� Garbage Grinder-. _Lot Size. <br /> . '..:.. ...:.. Private <br /> Water Su I Public System and norne,. . ....". .� <br /> Pp Y `101:1; <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt ❑ Clay.l Peat ❑ , Sandy Laam Clay r <br /> if eS, type.......... ... . .... . ". <br /> • hiardpnn ❑ Adobe{] FillMaterial ,- Y Yp � - <br /> �_ <br /> ;plat plan, showing size of lot, location of system in relation to wells, building`s, etc• must be placed an reverse side.) �`!, <br /> NEW INSTALLATION: tNo septicltank or seepage pit permitted if public sewer is available <br /> within 200 feet,) T <br /> r / Liquid Depth . .... .. .. .......� <br /> 'SEPTIC TANK ize.. <br /> PACKAGE TREATMENT., { ] �� ,(�C .•.•.__No. Compartments <br /> ,Material..... .. ..... ... � <br /> Capacity ..r'-.. ...._..Type... ..... ' �� <br /> 'r <br /> ProP• L'ine. <br /> Foundation_- <br /> Distance to nearest: Welt . � Total Length r. <br /> .,_, <br /> .�..__ <br /> No. of Lines Length of each line LEACHING LINE <br /> 'D''3ax. .� Type Filter Material Depth Filter Material. J. <br /> _ ... ._.. <br /> �., <br /> ....PropertyLine..... .. <br /> Distance to nearest: Well .._ �_. .. Rock Filled Yes L No <br /> I <br /> ..Diameter............. ..... Number - <br /> SEEPAGE PIT J } Depth .. .. . -_-. . <br /> t <br /> .---....Rock Size_ <br /> Water <br /> i � <br /> Line.. .--- -. . . <br /> Table Depth Prop. <br /> ..,-.-..-Foundation <br /> . .... _.. . ..... <br /> Distonce.to nearest: Well......... ..... .... . ..... <br /> REPAIR/ADDITION (PTev. Sanitation Permit ............. <br /> ---...Date---••........ .. .. .. .. "... <br /> l Septic Tank (Specify Requirements)...... ........ ........ - ----- ---... <br /> Disposal Field tSpecify Requirements).. .. _ . .... <br /> _ .... - - <br /> ;,�'. .. . .......... .... ... ..... .... ..._. <br /> dance with Son <br /> (Draw existing and requited addition on reverse side <br /> I hereby certify that I have prepared this application and thainLocalHealth District. Home owner orilicensed agenoaqvin ts <br /> t the work will d <br /> Ordinances, State Laws, and Rules and Regulafions of the San Joaq <br /> signatore certifies the following: person in such manner as <br /> t ,, certify that in the performance of the work for which this permit is issued, I shalt no* employ any <br /> f to became subject to Workman's Compensation laws of California.- <br /> Owner <br /> lSigned.... .... ... .. ..... .... .... <br /> Title._ _... <br /> .. ......... <br /> By....... ... . . .. ... 4w"o-'ther than owner) <br /> FOR DEPARTMENT USE ONLY' <br /> ...,DATE <br /> �--- -- <br /> ........_ .. .......... ... .... <br /> APPLICATION ACCEPTED BY_.. DATE. <br /> DIVISION OF LAND NUM <br /> ADDITIONAL COMMENTS, <br /> Final Inspection by:.... <br /> - .. .. ............... ..... .... ....... .. rrs 21677 REV. 7/1G 3 <br /> SAN JOAt�,UtN LOCAL'-HEALTH DISTRICT <br /> ew 73 24 <br />