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rOR OFFICE USE a� APPLICATION FOR SANITATION PERMIT <br /> l <br /> (Complete in Triplicate) <br /> This Permit Expires 1 Yew From Date Issued Date Issued <br /> App!:-ation is hcreby mode to the Son Joaquin Local Health District for a permit to construct and install the work herein <br /> deuribad. This apps'cation is made in compliance with County Ordinance No. 5.I9 and existing Rules and Regulotiafs: <br /> JOB ADDRESS rLOCAnON ���ry _. . _..�%� �••G '�� •ti '"�'�/ CENSUS TRACT <br /> Owner's Name .:i r_. �l.l•.T, �'cr/7,Q•. � . .. .. .. ... Phone <br /> Address ,l ""'- 'f . .... City -: �<!c �!1 .. . _. _. ... <br /> Contractor's Name 7 / I..KOf/ 1... if h . . .License# .a CVI7j.. Phone A11. <br /> w.... <br /> Installe ;on will serve: Residence❑Apartment House❑ Commerclolgrailer Court ❑ <br /> Motel ❑Other . ._... .............................. <br /> Number of living units: Number of bedrooms .......Garbage Grinder Lot Sim '�!%•1 G <br /> .. ............... <br /> Water Supply: Public System cud name _.. ...._ ... ... . _. _. ..... . .... . .. . Private' <br /> Character of soil to a depth of 3 feet: Sand ❑ Silt❑ Clay ❑ Peat❑ Sandy Loom ❑ Clay Loam ❑ <br /> Hardpan❑ Adobe R' Fill Material If yes,type <br /> (Plot plan, showiaq size of •,t, location of system in relation to wells, buildings, etc, must be placed on revers* side.) <br /> NEW INSTAILATION: INn seotic tank or seepage pit permitted ifpblic sewer is available within 200 feet,) �(s <br /> PACKAGE TREATMENT I1 SEPTIC TANKK r, �Size.��.ld.?�.S_, / Liquid Depth y..._.....__.. <br /> ,'ff�� <br /> ti •t <br /> Corwoyl-746 Type K',( :_$:./. Material. grti No. Compartments ..... .,. <br /> Durance to nearest: Well 5�7+ r y - <br /> _. . ._.._ _Fovfnldotioe w2 ,S Prop. Line <br /> LEACHING LINE >( No, of tines length of each line / Total length /. <br /> 'D' ?ox Type Filter Material (t<kbeprh Filter Material /d ............�.... <br /> Distnrce to neamst, Well ~ Foundation ,� r Property line .5..... .............. <br /> SEEPAGE PIT Depth .�+ Diameter .' ._ . Numbe• Rock Filled Y,4Ar No Q <br /> •• <br /> Water Tns.4 Depth G" n __..Rock Sire � ,Y... .. ' <br /> D,vtnnce to nearest, Well /C%r' _ . ..Foundation ,i.fir Prop. I.IGe <br /> REPAIR/ADDITION(Prey. Saaitmion Permit .P _. . .. Date <br /> Septic Tank (Speedy Prqu,rrvmmUl <br /> Disposal Field ;Sprr,fy Penu"ements) ( {` ` J! ' •' J <br /> IDrow existing and required addition on reverse side) <br /> I herby certify $hat t bnv* prepared this application and that the work will be done In accordance with Sen Jeegv n <br /> County Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health Di;Met. Homo owner or 11cen- <br /> sed agents slgno,•,*cart firs t6*following: <br /> W comfy that in the peder-.once of the work for which this permit Is Issued, 1 shall tset employ any person In such metmer <br /> as to becofw subject to!Votkman's Compensation taws of California." <br /> Signed , Owner <br /> BY , ... .. . .. _ _. Title <br /> (if other than10 c'r:ne'I <br /> _ FOR DEPARTMENT USE ONLY <br /> _ _. <br /> APPLICATION ACCEPTED BY DATE CT-11- 7d . <br /> BUILDING PERMIT ISSUED DATE <br /> ADDITIONAL COn'r•'ENTS <br /> Feel Inspect,on by �1iL'1{ �- �' Dote �' 14 `7V <br />