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FOR OFFICE USE: <br /> .................. ............ APPLICATION FOR SANITATION PERMIT <br /> ......... ......................... . lCompleto In TrIplicato) Permit <br /> .L.. <br /> .......... ......................... This Permit Expires I Year From Datelssved Date <br /> H <br /> Application is hereby macill to the Son Joaquin Local Health District for.1 a permit to-construct and Install the work herein <br /> described. This applicatioW,Is made in complia ce with County Ordinance No <br /> 549 and existing Rules and Regulations: <br /> JOB ADDRESSAOCAT10 N.,............. ......................... . ....... ................. ...................... .......CENSUS TRACT ........... ............... <br /> Owner's Name <br /> I------- --- ------ ............. ..........Phone ................... <br /> - -- ------ ............... ..... <br /> Address ...... ...... <br /> . .. ................ <br /> City .... ...................... <br /> Contractor's Name ---- -- -• --------------- <br /> �_�p apartment 14, <br /> I r ristallation will serve. J7 . .. .. .. .......Q.....A--v.�lcense # Phone ......•1�...................... <br /> Residen eApartment House f] Commercial oTroller Couit <br /> Motel0 Other..............-........ ....... ........... <br /> Number of living units: <br /> ... Number of bedrooms GaibWe-GiIK&r—,'.-- <br /> Lot size .......11................................. <br /> Water Supply. Public System and name ................... <br /> . .................................... ............................................... .......Private <br /> Character of soil to a depth"of 3 feet: Sand 0 Slit 0 Clay LoamU100"peat 0 Sandy toa4 Clay Loam C3 <br /> _ , O <br /> Hardpan 0 Adobe 0 Fill Material ............ if yes,type pe.............. ............. <br /> (Plot Plan, showing size of 'lot, location of system In relation to Wei is-66flclin -gs:_ - <br /> o-- etc. must be pl,66ed an reverse side.) <br /> NEW INSTALLATION: •(No septic tank or;seepage pit permitted If public sewer Is available within 200 feet,1 <br /> f ]11 <br /> PACKAGE TREATMENT SEPTIC TANK[ Size................... <br /> ...............I............. Liquid Depth .......................... <br /> Capacity ------------ ....... Type ................. <br /> ... Material.................. .... No. Compartments <br /> .................... <br /> Distance.to nearest: Well .................. ........:-Favriclotion ...................... Prop. Line ...................... <br /> c. <br /> LEACHING LINE, Noil of Lines ............ ........... Length of each line- <br /> . ........................ Total Length ............................ <br /> 'D' Box ......:..... Type filter Material ....................;D6pth4ilter-Material ............. ........................ <br /> Distbrice to nearest. Well ................. ...... Foundation .......---•--`........... Property Line ........................ <br /> 11 Ji <br /> SEEPAGE PIT, Depth .................... Diameter ................ Number .................. ... Rock Filled Yes 0 No <br /> 11 0 <br /> Watbr Table Depth ..............­1..............................Rock Size ........ <br /> ................. ...... <br /> Distance to nearest: Well ................ .......................Foundation.......... ........... PropLine ........... .......... <br /> !EPAIR/ADDITION(Prov. SorWitation Permit# .................. .................. Date ......... <br /> ........... <br /> Septic Tank (Specify Requirements) ........ ........ .......... ............ ........... <br /> ............ .......I........................ ........... ....... ........... <br /> ' quiremen <br /> .1 _-VIL <br /> Disposal Fiel Specify, Requirements) ...... ... <br /> 4 1 . -, , <br /> ya_." - �_ _— J <br /> ............... .............. ........................ <br /> _­_-)_&4,0... ....... ... ........ ... ......... ..4w­......... <br /> ............... -------------- -------- ---------I—.......... ------ ----------- -------------- - <br /> i. ........... .................I............. <br /> (Draw e fisting and required ad-d'i'ti"o'no"n"reverse...side) <br /> I hereby certify that I have Orepared 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 Haalth:District. mom* owner or !horn <br /> sed agents signature certifieilthe following: <br /> "I certify that in the perform'qnce of the work for which this permit Is issued, I shall not laws of California.- <br /> P emiloy any person In such manner <br /> as to become subject to Workman's Compensation <br /> Signed ------_---------- <br /> ........ Owner <br /> By --------- ----------------- <br /> Yitle _.,A ------ -_ <br /> (If other than owner) <br /> FOR DEPARTMENT USE.ONLY <br /> APPLICATION ACCEPTED BYE.--..-. --------------------­---- -------------------------- ---­---------- DATE <br /> BUILDING PERMIT ISSUED ---i--. ........ ........ ..... <br /> ADDITIONALCOMMENTS .,__0 .... ......................___.........................I............. ......... ...........-_-DATE .... ...................­-­ <br /> �I-----------------------------------------------------------------------------I'll-------I---------­_11------------­------- .........................- <br /> ---------------------I------ ------------1-1---------- ---------------------------------------------------------------- ---------------I------ -1-1----------------------­­­....... ......­ I <br /> ................................. ...........11 ----- ---------------------------------- -----------•----- ------------------------ ........... ..................... ............. <br /> ii-------------- <br /> -----------................................... <br /> Finol Inspection by: ................i,i ------------I----------------------------- .......... ------------------­--- <br /> ..........11-1......... .......................... Date .... ............ <br /> 7' <br /> EH 13 2h 1-68 liev. 2- � ......... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 18/711 3M <br />