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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> !�... permit No.2.6 7 <br /> o / ECornplete In Triplicate) <br /> .. Date 7�-7 <br /> ,. Issued �..... <br /> fi.. _ ..._ This Permit Expires-t Year From Doh Issued � - - <br /> Application Is hereby made to the Sari Joaquin local Health Dlstflct'for-a-.permit to construct and Install the work herein <br /> described. This application is mode}in compliance with County Ordinance No. 544 and existing Rules and Regulations: I <br /> ....CENSUS TRACT / ° <br /> JOB ADDRESS/LOCATI u?':' .. 7-0... (I <br /> �noy// ......... <br /> Owner's Name ...--.. .�. �� . .ls .. � ................................... Phase 1�. ............. <br /> i,iddress ................-_... _ _ ................. City ............. .. M.... ..._... ... ....... <br /> ` '' - �..a1 -----.license �.. ` _ : . Phone <br /> Contractor's Nome .'........ ..............•--..... • . ...... ....-•• ...... ._....... <br /> Installation will serve: Residence (Apartment House❑ Commercial Moller Court 0 <br /> Motel p Oth '_ .....................•...... ...... <br /> Number of living units:............. Number of bedrooms .............Garbage Grind ............ Lot Size ._:��...�. ............... <br /> fs <br /> 1 <br /> Water Supply: Public System and name ..............................._......................... ..................................Private ❑ <br /> Character of soil to a depth of 3 feet Sand 0 Silt Q Clay Peat E] Sandy loam 0 Clay Loam ❑ <br /> Hardpan❑ Adobe Fill Materia! ............. If yes,type............... ............ <br /> !Plot plan, showing size of lot, location of system In relation to wells, buildings, etc. must Iia placed on reverse side.) <br /> NEW INSTALLATION: lNo septic tank or seepage pit permitted if public sewer is available within 260afeet,) <br /> PACKAGE TREATMENT ] SEPTIC TANK.O. SI e........ate... :. ....................... liquid -Depth .......tom..:....•••...... <br /> Capacity � J's Tgpe:_14 .. Materia):..: : ' 'No. Compartments ..... �-------- <br /> .. '-foundation <br /> Distance to nearest: Well .... •...: ... .. . . .......... Prop. Line ..��. ...---- <br /> -EACHING LINE No. of Lin" ` ............. Length of each line...........a�.......... Total Length ..;Ug........... <br /> 'D' Box ✓;-Type Filter Material ... � . .Depth Filter Material ----------Z Erf.. ....- -••••••- <br /> 'Distance'to nearest: Well ....... .......... Foundation ...fo.............. Property Line ... �?.:••••.-•• <br /> SEEPAGE PIT Depth . . Diajmeter . I..... Number .......l. Rock Filled Yes <br /> � r ....... fI �, No0 <br /> Water Table .Deptfi. ....... •..................... :..Rack Site ., ... ./. ...-... <br /> Distance,to nearest: Well ...................................•--..foundation . ... ...' ... Prop. line .. .,............. <br /> REPAIR/ADDITION(Prey- Sanitation Permit# ............................................. Date ............... -••-••......- •} <br /> SepticTank )Specify Requirements .................................... ....•---- -_.... ........................................ ......_...._................ F <br /> Disgosa! Field (Specify Requirements ...................................--_-•_-• <br /> .......................................... <br /> . ................................. .............................................I....................n.................................. <br /> ....._.._...,.......................................I.........----..............................................•.•..._...........• •....................................................... h <br /> J'(Draw existing and required addition an reverse side) <br /> I hereby certify that I have prepared this application and that the work w1l!_be done In accordance with San Joaquin <br /> J. Ordinances, State laws, and Rules and Regulations of the San Joaquin Local Health Distrid. Home owner or Ilton- <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 In such manner <br /> as to become subject to Workman's Compensation laws of California." , {. , <br /> � caner <br /> anee ..... <br /> •--•............................ ........................................ <br /> _ .......sy (If . <br /> other n owner) . <br /> R D ARTMENT USE ONLY <br /> APPLICATION ACCEPT D BY -... _ .....:..........;............._-.'•-•-•• -. ..... <br /> _.: �. . <br /> DATE dA` -� <br /> BUILDING PERMIT ISSUED DATE>............................... ........... r <br /> ADDITIONAL COMMENTS .. ..... ..... .. ......... ................... _............ ........... _.................I...---•....._.. J <br /> . . .................... ... -- ................ ................ ......'.- . ......-- ............. .......... .....--.............__............... • <br /> :, �ij. <br /> ....--... .. ....... ................:....................--.........:............................ -......... . .----....._..... ; <br /> Final Inspection by: .-_... .. <br /> .- ..............................Date .... .....�.,�..-. ..:G .-..._-.._._.... <br /> EH 13 2!t 1'6h <br /> SAW OAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br /> � 2 <br />