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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT � <br />.......--- --�•---�-............................... _ �...... .. <br /> (Complete in Triplicate) Permit No. ... ..._ <br /> ....................................... <br /> ........... This Permit Expires 1 Year From Date Issued 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 application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION �`?: :. . ..��_. � �-�^- CENSUS_TRACT .:...,............----•---:.. <br /> .-_ -- _. �"�":fir-z�J �_... _...._., .� _. +. <br /> Owner's Name ..... <br /> Address 02. A. lc `� City .................. <br /> Phone <br /> ... ............. ... s <br /> Contractor's Name -. _. . .' - . •.: :`.License'# :1 '�f .- _ Phone '---. ................... <br /> Installation will serve: Residence bj"Xpartment House,(-Commercial []Trailer Court",❑; <br /> Motel <br /> of living units:..... Number of. b❑edr oms _------Garbo9.e. G,r.i-n. der. __ L-ot Size. ; <br /> --- ._. :. . . O <br /> Water Supply: Public System and name .. n: --Silt -- ------Cla Peat ....Sandy L•--. . L --------- ----------Privote <br /> Character of soil to a depth of 3 feet: Sand ❑ oam:�Clay LOam ❑ <br /> Hardpan [l Adobe ❑ Fill Material . If yes, type - <br /> (plot plan, showing size..of.lot-]a' ti6n.of system'.in !relation_to wells, buildings, etc_ must be placed on revorse.side:) <br /> N4EW INSTALLATION: (No septic tank or seepage;pit permitted,if public sewer is a'vailoble.:within.200 feet,)' } <br /> PACKAGE TREATMENT SEPTIC TANK' 1" Siz X!_._1� -. <br /> { ] t'7 Size.. Liquid Depth . ............. <br /> Capacity a`�? �' Type ` Material :.._. :No. Compartments ' ............ <br /> _ : Well .5., G ;. ..Foundation �....�.. Prop. Line .......... <br /> .... . <br /> Distance to nearest,, <br /> LEACHING LINE [J/f No. of Lines - . .. Len th of each line... Total Length t.] <br /> Q <br /> D' Boz `::..!. . .'Type'Filter Mate 'al ..___-_5. _-.: Depth',Fiiter Material _ --1.�1-."------- ---- -----------•__-. <br /> iF:..:.f �.L Foundation' ------ <br /> _.-. <br /> i Property 'Line <br /> Distance to nearest: Well Fo <br /> Si EPAGE PIT [► Depth `... a:. Diameter _ _ _..".:.. Number :,:....: . ........Rock Filled Yes No C3 <br /> Water Table. De th:....... .....:.- / �•` <br /> p ................Rock Size.':�. . ._._:./..3--= . <br /> Distance to nearest:.Well <br /> •:•:.--= Foundation_ _...,.. .�rJ. -'�. Prop. Line - 74• -•j <br /> REPAIR/ADDITION(Prev. Sanitation,Permit# ::.-.- 'Date ....: ..... ......... ) <br /> ;Septic Tank (Specify Requirements) ..<,... ...... ............... .............................................. -- <br /> Disposal Field (Specify Requirements) -- ------------ .---...."-." -------------- ......... <br /> ............................ ... ..-. ......... .......... ............ ---"-- ------.---......-- .... ............. .... ............. ------------- <br /> ............. <br /> -----............. ...... . --............. ......_...... --..... . --..... ---......-- ---. ..-..._....... - : --- _----..- <br /> (Drdw existingand required addition on reverse side) " <br /> 4 <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 [icon• <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 iri such manner <br /> as to become subject to Workman"s.Compensation laws of California'." <br /> Signed - ---- Owner... <br /> SY .......... .......... u . -: � .. Title <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..... .C.�' .^. �_......-... ......----..._. DATE ---------- <br /> BUILDING PERMIT ISSUED ..............: ..:..:.. ...........`-... ...................._---- ...--..DATE <br /> ADDITIONAL COMMENTS ........ ---------- --" - ......,...... ,.......__..._:_._.._.............:.. y <br /> ..................... . ... .. ........... .. . - -•------- <br /> ...............• <br /> ................. <br /> Final Inspection b ....... -. -- ................ ......_Date fes.-! .......7 -------------- <br /> SAN 'JOAQUIN LOCAL HEALTWDIStkICT <br /> 4. 1 94 <br />