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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ..................................:._._......._..--_.. Permit No. ................ <br /> {Complete in Triplicate) <br />......................................................•-•• <br /> Date Issued .....-_........ <br /> ................................I......__........,._ This Permit Expires 1 Year From Date issued <br /> Application is hereby made-to the-Son 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 /> �LZ' a i�� .......CONSUS TRACT .......................... <br /> JOB ADDRESS/LOC ON /..'J '. r3 .-------• ..._....-- '............... <br /> Owner's Name .. '� �� - ' .......................................:.........,... One . ....7 .. ..__ <br /> Address . ...:.......... ty ...._....•............. <br /> Contractor's Name --------....i°1_ ---------------}---------- ._..._.... '` :.........._.....License # ._:................. Phone .........................__._. <br /> Installation will serve: `9 idence%,Apartment House Q Commercial QTrailer Court 0 <br /> 1 Motel Q Other--•-•------•-•----•--•--•................... 17 , <br /> Number of living units_____________ Number of bedrQ ..._ms _ G babe Grinder ._ Lot Saxe 7 ?.. ....-- <br /> � <br /> Water Supply: Public System and name ...q/ J " Co Private Q <br /> < - .... .... .... �...:.w <br /> Character of sail to 6 depth of 3 feet: Sand Q - Slit Q Clay_)K(' Peat❑ Sandy Loam 0 Clay Loam <br /> Hardpan-Q Adobe 0 Fill Material .... .......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 /> NEW INSTALLATION: (No septic tank or seepage'pit permitted if public,sewer is available within 200 feet,# <br /> � d <br /> PACKAGE TREATMENT f ) SEPTIC TA14KI ] 'Size...........: .......................••••.. Liquid Depth <br /> t f7 <br /> Capacity`�� �1 l� TYPe g � �Materiai-- ----------------- No. Compartments .. ..........:Jr <br /> :5 <br /> 1 <br /> Distance to neorest: .Wel!- I Y7, --•--.------.Foundation ...................... Prop. Line ...................... <br /> LEACHING LINE ] No. of Lines --------- .. _- Length of each line---------------------------- Total Length <br /> 'D' Box ------------ Type Filter. _Q.,Material --_--------_- pth4Filter Material ............................................ . 1 <br /> � f <br /> Distance to nearest: Well - --------------------- Foundation ......................_. Property Line .................... 9 <br /> ( ) Depth ---' -�--.--.. Diameter 4:? -Number ------------------ ........ Rack Filled Yes M/ No Q (. <br /> Waters Table--Depth ` r` Y . Rock-Size <br /> L <br /> Distance to nearest: Wel! ..5o 6rgl`v 1 foundation Prop. Line •- ••--••••••-- <br /> REPAIR/ADDITION{Prev. Sanitation`Permit# -------------------------------- ------•• - Date ---_------------_--_------ <br /> Septic <br /> --•--.-.-- _------Septic Tank (Specify Requirements) •-= �..... ...................................•------•-••••...........-•----•...__..............--•---••---- ........... <br /> Disposal Field {Specify Requirements) -----------------------------------------------------------­----------------- ---._..-•-----------------......------........ <br /> 1:4. 1 <br /> , <br /> •----------------------------------------------•---------------- . •--•- <br /> ----------•- ---. --------•----. ------- -••--•--•• .......................... <br /> ---------- <br /> I <br /> t. (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 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 Iken- <br /> sed agents signature certifies the fallowing: <br /> "1 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 be <br /> a subj ct t W o a of California. <br /> Signed _ = ------------------ Owner <br /> BY ------------------- --------------- _-_----- Title ----...._ ........................ ------------------ ........ --------- <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY / <br /> i APPLICATION ACCEPTED BY __�.. _ .. _._._. -----. DATE ...- '---1.--..7.6, <br /> BUILDING PERMIT ISSUED - ' . ---.... . ^ .---------------------DATE ............. . ---------` <br /> } ADDITIONAL COMMENTS ° 'n U/[-° x�J..._, -/2•�7Ga........ <br /> ------. ---- <br /> •------------•----- <br /> ------ <br /> Final Inspection b - •-- ........Date .... .� .rf6.--.... ... <br /> EH 13 241-6f3 Rev. SAN JOAQUIN LOCAL HEALTH DISTRICT 87h 3M <br /> CIPF <br /> I <br />