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FOR OFFICE USE: APPLICATION <br /> FOR SANITATION PERMIT tNo:..::. : Permi . ...... ---__.�....� - <br /> I. <br /> !Complete In Triplicate) <br /> A . <br /> `..... <br /> .. This Permit Expires 1 Year From Date Issued Date Issued .... 7.. ....... <br /> IM a <br /> Application is hereby made to the San Joaquin'local Health District for a permit to constrict and install the work herein i <br /> described. This application is made in compliance with County�Ordonce No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS LOCATI Ni .. ..-__.. .. ......................................................CENSUS TRACT ...............-----...... <br /> Owner's Name _ / ..Phone ....... <br /> `fes <br /> Address .C%"-_. 4e... City lqL"J / d.:.................................. <br /> Contractor's Name .__..._. . ..... ¢'�5...•.............. ___...License ��` ,°~ Phare <br /> ...... <br /> Installation will serve: Residence of Apartment)douse C] Commercial❑Trotter Court JJ <br /> Motel ❑Other............................................. <br /> Number of`living units:......: Number of bedrooms Garbage Grinderl4.6.. Lot Size , . ............. <br /> Water Supply: Public System and name -----------.............................................._...................................................Privates <br /> Character of soil to a depth of 3 feet: Sand 0 Silt❑ Clay ❑ Peat❑ Sandy Loam 0 Clay loam ❑ <br /> Hardpan 0 AdabeX Fitt Material ............ If yes,type............... ............ <br /> {Plot plan, showing size o€ lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> 4. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If pyblic sewer is available within 200 feet,) <br /> PACKAGE TREATMENT 1 ] SEPTIC TANK;4 S'ze..���.�1P.X.4................... Liquid Depth . <br /> Ca ac: ... --- • ••-• <br /> Shp ty,fpf' Type `Materialft .t.:... No. Compartments oZ .---•�- <br /> flilstance.to nearest: Well ...-_�-�-O....-------------Foundation ..1a........... Prop. Line ..02........... <br /> LEACHING LINE N k. of Lines .- .............. Length of each line/l1 -.��P. ?�.. Total Length ., 1___......_... <br /> 1a..Depth Filter Material// `-"-.....-, <br /> 'i)� Box ?-:P. Type Filter Material� p ......... <br /> Di$tan a to nearest: Well aellp............ Foundat.ion...-/(�...::.......... Property tine ....4. .............. <br /> SEEPAGE.PIT l j Depth ..........:.. .:_DiamAeter:-:::..-:. -Number � ............ Rock Filled Yes ❑ No 0 <br /> Water Table Depth ••-----------• ......................... - ----.Rock Size ---- ........................... <br /> Distance to nearest: Well =;=-`-'..............:...............FoundafFon .................... Prop. Line ........----.......... , <br /> REPAIR/ADDITION lPrev. Sanitation Permit ` .._._.._-..__:,. ......................... ............................ <br /> � , <br /> Septic Tank (Specify Requirements).........°....... -.............. =- { --........... ••-•-•• ............... <br /> ......,,.._ <br /> Disposal Field (Specify Requirements). --------------- � ��� . <br /> ----------------------------- •----- ----- <br /> --------------•-----------••--- --..,._ ---•------- .................... ......................................................... <br /> j( lDraw existing and required addition on reverse side) <br /> I hereby certify that I:ha prepared this application and that the work will'be done In accordance with Son Joaquin <br /> County Ordinances, State laws, and'-Rulas-and-goo uldtiont oU*6-Sao Joaqulrt°LocaF Health,District. home owner or licen- <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,nnot employ any person in such manner <br /> as to become subject toWorkman's Compensation laws of California." <br /> Signed ................. ... ... ...1 ---- • ---- ---•--... Owner <br /> By . ................ Title _ <br /> . - -. Via'."._!-........__...--................................ <br /> { er than`o nerl <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- - ----- - -------- .._.._._.. DATE._._._:. - ":26_.- <br /> BUILDINGPERMIT iSSll1=D:----------------------••-•-•--• --••------•-•--- •-------------------------------.._.._....-------.._...-DATE ... -----­-­------------------ <br /> . ADDITIONAL COMMENTS 1II-•[-�-U--_•-J-•7..�...�.Z...�.....f.3.._.f3�......k._._...�.9. <br /> PR o_X: ._�= .. J.M ..._.. <br /> --- <br /> ------------------------------ <br /> - <br /> ,; <br /> .. 'M ---••----- -- -. -•---• ....... .. _ --------------------------- <br /> s y! <br /> .. ..._-�___________________________________________________________---------------.-_...,.._.._. _. _ .......... _ �i <br /> •, .__.._________________________ <br /> f=inal ins action b -� ' �� _-._©ate _._ .�- �o"! � ..------ <br /> p Y' ......... ........... <br /> Eli 13 2h 1--b ,`Rev 5M SAN JOAQUIN LOCAL HEALTH DI RIOT 8/7)I 3M ��r^ <br /> k, yt <br /> i -1` - <br />