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FOR OFFICE USE: ' <br /> APPLICATION FOR SANITATION PERMIT 7 7_flz3 <br /> .................................................... (Cansplete in Taipllcatm) Permit No. ... ...... . <br /> ....................................I...... . <br />.......................... .... .. . . .. This Permit Expires 1 Year Front 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 Regutationst <br /> 'JOB ADDR SS/L S BION� , � � `.:.:. ... ........ ........CENSUS TRACT ..... ............... <br /> Owner's'Name ...... .. ................................... ... . ..!...:......................Phone ,�. �f��� ............. <br /> Address ..... .......... . �� �. i :........................... ............City - ..., .... ................................................ <br /> Contractor's Name ..1 y ... ... --•.........:.....:................•---...License s iFf— Phone -�-r_:&✓f................. <br /> Installation will server 12=aldeoce�]Apartment Houses] Commercial railer Court 0 <br /> Mote Other...................... <br /> Number of living units:............ Number of bedrooms ............Garbage Grinder. ........ lot Size ............................................ <br /> Water.Suppiy: Public System and name ..................».-...................._. .... } ..................... ....Private <br /> Character of soil to a deptt,of 3 feet: Sand a.. Silt❑ Clay p Peat Q: Sandy Loans❑ Clay Warn f3 <br /> - <br /> } Hardpan p Adobe❑ Fill Materlal .. . . If yes.type............... ............ <br /> (Plot plan, shawl 4 hg-size of lot, location of system In relation to welts,dings,jetc. must be placed on reverse <br /> NEW INSTALLATION: IN* septic tonWor seepage pit permitted if,}public sewer is available.within 200 feet,) � <br /> PACKAGE TREATMENT { ] SEPTIC TANK{ ] Size............. .$............................... Liquid Depth .......................... Z <br /> Capacity . .......... Type ..................... Materlal...__.g_______ _______ No. Compartments ..............._.... <br /> Distance to jiearest: Well ....................................Foundation ...................... Prop. Line ___.- ..........- <br /> { l .-•--•..`..----- Length of each line... 7�� �--._....-•----.. Total Length ...7e. .............. <br /> LEACHING LINE No. of tines- <br /> `D' Sox Type Filter Material1. . .......Depth Filter Material ..................................... <br /> • , Distance to`nearest: Well ........................ Foundation ......................... Property line .................. � <br /> ..... <br /> SEEPAGE PIT E 9 Depth ..-----�............. Diameter. ................. Number .............................. Rack Filled Yes © Ho <br /> Water Table Depth .......:........................................Rack Size ........._........................ <br /> A <br /> Distance to nearest, Well .......................•__-_..__........Foundation --..._.._.__.._..._. Prop:.line ..................... <br /> REPAIR/ADDITION(Prov. Sanitation.Permit qlt 1 . <br /> ...............................•.......__.. Date ..._._.......................... C. <br /> Septic Tank )Specify Requirements) . l........................ ..•... . .. ......................._.. ....................._........ ............ - <br /> Disposal Field (Specify Requirements) . .................................................-• .•' ..... <br /> ....--•-•...................................••-----......._....-----..._................................-•-•---................---••-----------• ---.......................... .......................... <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this application and that the work will be done In accordancm with San Joaquin <br /> County Ordinances, State taws, and !toles and Regulations of the Son Joaquin Local Health Dlstrlct. Home owner or Ilcen- <br /> sed agents signature certifies the follo*ing: <br /> "!-certify that in_the_performance-of-fhe wewk far-which this=permlt Is Issued, I shall not employ any person In such mariner <br /> a: to become sub ectto rkrna 's Compensation laws ofXcilifamla" <br /> Signed ... , <br /> BY .... .... jitle <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED 6Y DATE - <br /> BUILDING PERMIT ISSUED . ................. .. ....----.......,.......... .. <br /> ADDITION COMMEAlTS ..... - -.-...._...-. <br /> .�.. <br /> `' ... ....... ..... <br /> ..............'....................... <br /> ............................................................................. ........................I................ ...... ............................... ........... <br /> .:.. ... ----- -•-• ..................................................Date Inspection by: :....��,..1 ,7...........: <br /> ... <br /> 13 2h 1-6 V- SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />