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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete inTriplicate) <br /> Permit o. <br /> � �a.ar�- <br /> ............ .. ... .. .. . __ __ <br /> --_ This Permit Expires 1 Year From Date Issued <br /> oDate Issued.3 <br /> .r. ... . . <br /> t E __. f{r _K__w tz s� - �y <br /> Application is hereby ma a to the San Joaquin Local Health District for a permit to construct arid Install tht w4 herein <br /> described. This application is made in compliance with County Ordinance No. 549 and existin RW 'Regulation . <br /> JOB ADDRESS/LOCATION _J.,�.�.------- - .. .1..3`31•�.L�.-4/_ T r C b.CENSU�................... _... <br /> Owner's Name ------- ---("„ - ...., -- - - - - Phone <br /> .-Address - - <br /> C <br /> Contractor's Name ------p�ii�rscld_ ..._ •__License # /FA'3F;;`_­phone .......4)-------....._ <br /> Installation will serve: Residence E]Apartment Ho se'❑ Co erc'ial IL"JTrailer C�uArt <br /> - Motel ❑Other ._ 4 E�4�D / <br /> Number of living units:..-,-----.-- Number of bedrooms .--.........Garbage G nde �,_�o�t Siizzee -- - ........... <br /> Water Supply: Public System and name ..................... ...... <br /> -_------...__._.-.._.-.-._.__Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat❑A �Sandy Loam Clay Loam ❑ <br /> Hardpan [:] Adobe E] Fill Material .../U4 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 /> PACKAGEATREATMENT (No sSEPTIC TANK seepa it permitted Zed i�public � iavailable within 200 feet,) � <br /> P P P r Py <br /> [ �j'/- { / ,Or w .. ., Liquid Depth --�7.----_---_------ <br /> CapaciTy c�'Tf! ... .. Tyll _V erial.. Y.Y L' - No. Compartments _1Q,........... <br /> i .S i <br /> Distbnce o near ft— __..I... ...........Foundation ------/0--------- Prop. Line --- ... <br /> LEACHING LINE [ No. of Lines .......o7........... L-ength of yyeach line..-../AG-------------- Total Length ..,=PAP........... <br /> 'D• Box ype Filter Material .1.4 -C..-..Depth Filter Material -----/y--� ........... <br /> Distance o nearest: Well ......./C3.Q...�. Foundation ..-�..�0--.---..-.- Property Line .�/........... <br /> SEEPAGE PIT [ ] Depth --------- ---------- Diameter ---------------- Number ..........._.-.__..... ... Rock Filled Yes ❑ No [ <br /> Water Table Depth .....Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation .................... Prop. Line .--------_-.------. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# .-----------------------------------------_ Date ----.-------..................... <br /> ) <br /> Septic Tank (Specify Requirements) ----------------- --------------------------------------------------------- ------------------ <br /> Disposal Field (Specify Requirements) <br /> t <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 Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents sigriature 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 /> Signed ------------------------- -- - - ._...._ .._ <br /> By - -.......................... -` -- <br /> (If other than owner) <br /> FOR DEPARTMENT USE ONLY------' <br /> APPLICATION ACCEPTED BY _... ...... re2n,<o ------------------------------------------------------ DATED ` 9---------- ---- <br /> BUILDING PERMIT ISSUED .--- .--- . -----{-------} ,t,- --_-- ....... DATE -------------------------- -1 COMMENTS . _.[ -..,11 Etas. ---- 2�n qty{.-..r.....// L'.d�----- � ----- <br /> .._ <br /> ---' <br /> _- ------------------------------------ - - ---- ---- - --------------------------------------------- --- ---------------------------------- ---- ----------....--------' " <br /> -----...---------- -......... �. .... - _ �7 - <br /> ---' <br /> Final Inspection by: ...- '-'- - ---- . _ -----------------------------..Date - -- ---- ----..1....-................ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> C u n t 1�0 D_.- cu <br />