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FOR OFFICE USE: <br /> `APPLICATION FOR SANITATION PER1Rt( <br /> - - - - - <br /> ---------- `( (Complete in Triplicate) Permit No. __- --- <br /> w.-__._---___ -------------- --------- ....... This Permit Expires 1 Year From Date Issued <br /> Date Issued <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 appltcation is made in compliance with County (Drdinance No. 549 and:existing Rules and Regulations: <br /> ` JOB ADDRESS}(`OLATION - - - jl;m-e -------------- ------L--CENSUS TRACT --------------------- - <br /> Owner's 41ame - ev �'�f�`C -•- - Phone ------------------------------------ <br /> j6 <br /> - - <br /> t <br /> Address +`kt `--- - �7✓ - Ci 11. -------------------------------- - <br /> ' +� <br /> fi _ ,. - <br /> Contractor's Name - �/ ✓l�Y�° --------- - I .License # ---- - �-- .... Phone --------------------------- <br /> ` Installati will serve: I Residenc4-❑Apai�tme�House C 'mmercial�ITrailer Cowl❑ <br /> o;el ❑O/thgr'- ---------------- --------------------- <br /> Number of living units:..."� --- Numis of bedrooms _=.....Ctbarbage Grinder -- Lot Size _�------------------ <br /> Water SuiSply: Public System and nam ..------- ------ ---------------1- --fit------------------Privateer. <br /> Charactep,of soil to a depth f 3 feet• /-�an Silt❑ CJby ❑ Peat❑ Sandy Loam o`: Clay Loam L7 <br /> ` I r8pan ] Adobe Q Fill Material ------------ If yes,type------- <br /> ------------------- <br /> S , <br /> (Plot plan, howing size c' I0*`loc ioJof stem in relation to wells, buildings, etc. must be pid ed on reverse side.) <br /> NEW INSTALLATION: [ o septic tank or seBpage pit p@rmitted if public sewer is available within 2® feet,) <br /> PACKAG TREATMENT SEPTIC TANK ! Size--Z/P yp 04- <br /> ,Size--Z-,e <br /> I � { 7 �'X- 1`----------`-----.. Liquid D pth ._1-�-/------....-- <br /> X Capacity �p..._p. Typef1F`�✓4�_ Material�!/3y No. Compartments ___.................. <br /> / // / ZIP <br /> � <br /> Distance Jz near st- Filtlll -.1 -------------------Foundation - �--.---------- Prop ,me �aQ.....---.--. <br /> LEACHItSG LINE No. oftL' ¢s ___ - Length of each line. .U�-------- Total Lengt 1� --.- <br /> f l o ` <br /> -- <br /> ` ✓� <br /> _ e Matenol -X. Depth Filter Material l�... <br /> t ncI- I 14 / - -- Foundation �r --- -- -_. Property' Lime / <br /> SEEPAGE PIT [ ] }�D!I�pth tjZjC/,fir. D ai�et ref ._.__- Number . . --------------------- Rock Filled #,,e No ,[] <br /> gate lb Depth __ ` _ -Rock Size .uly - <br /> - _ <br /> I t <br /> Distange to nearest: Well 4 <br /> _ -_ ...Foundation / P_...... Prop., Lina u&.-_......... \ <br /> REPAIk-/ADDITION(Prev. Sanitation Pe{mit -----if _ . Date --------------------........ ) <br /> Septic Tank (Specify Requiretments) ..___ - - ---------------------------------------------------------_ -_-- . ............... <br /> Disposal' ie9d'j5 L'�1fyi`Re uireme .. . . ..._.. . ._.. <br /> - <br /> s i 9�.5- ya3}._ . ... - ---- - ---- --- ------' -- <br /> `, tea a. i <br /> •eel�� (Draw existing and required addition on reverse side) <br /> .. kA.here�yacertify that I have jirep this application and that the work will be done in accordance with San Joaquin <br /> Ciounty rdinances, State Laws, n Rules and Regulations of the San Joaquin Local Health District. Home owner of licen- <br /> st d agents signature certifies the following: <br /> Lcertify that in the performance of the work for whi`�st,-;thii Armit is issued, t shall not employ any person in such manner <br /> as�to become subject to Workman's Compensation lale^of California."Signed . <br /> �\ l <br /> -- --- ----- - ---- ------------ --- Owner <br /> By ... <br /> If other t an owner <br /> LAPPLICATION ACCEPTED BY _----_--------------------FOR DEPARTMENT USE-ONLY------------------ -- DATE -------_-----------__----------.-------.- <br /> BUILDING PERMIT ISSUED --------------------------------------------------- ------- --------------------------------------DATE --- -------- ----- <br /> LADDITIONAL COMMENTS -------------------------- --------------------------------'-------- -------------------------------- ------------------- <br /> ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ <br /> --------------------------------------------------------------------'------------------------------------------ <br /> ---------------------------------- ---------------------------------------------------------------------- - <br /> - - <br /> - - <br /> - ----------'------ <br /> Final Inspection by: _----------------------- ---..------------------------ --------------Date -----------r .-72------------- <br /> - - <br /> L SAN JOAQUI�i LOCAL HE DISTRICT <br />