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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> :_.__._`'........................•••----•---.._ <br /> iComplete in Triplicate] Permit ...... <br /> Pe It Na :7S�7 <br /> ..................... <br /> ........................... ............... This Permit Expires 1 Year From Date Issued <br /> Date issued -�_4 <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 Regulations. <br /> JOB ADDRf55/LOCATI ___.- CENSUS TRACT <br /> - .. ... --•--•. ... ............................................... ...... --•--...... <br /> 'G <br /> Address ... ....•• .. __...._ j' ............................:...:....... ... ...Rhone <br /> Owner's Name ............ ........ <br /> ................... ..7 ...:city ... �.. . <br /> i . `� <br /> ........License ......Phone` ' 7 <br /> Contractor's Name '.. ................. y .•3 •-••`-��': U,0 7- <br /> Installation will serve: Residence( partment House{, Commercial OTraller Court 0 <br /> F <br /> Number of living units...: Number of bedrooms .._ ��Garbage Grinder ...__ ot,:Size ...(01-S.2)..................... <br /> Water Supply: Public System and name ....:.._.I.... I u, �"�� � Private Q <br /> ► �� ij ......... <br /> Character of soil to a depth of 3 feet: Sand 0 Sift❑ day€o Peat❑"'Sandy Loam•]:---••Clay Loam❑ <br /> .• t <br /> Hardpan p Adobe VIII 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 /> ,'4 , <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer"is•'available within 200 feet,} <br /> PACKAGE TREATMENT [ ] SEPTIC TANK( Sizi................ ....:......................... Liquid Depth ...................... <br /> Capacity •-----•------------- Type --------- ----- Material___----•--------....,: No. Compartments. ..:::............. <br /> Distance to nearest: Well .Foundation Prop. Line ......> r <br /> ----------------•----............. �... ..... ......... <br /> LEACHING LINE O No. of Lines ----------------------- LengtIN64' each line__••_....................... Total length ..........__-__-.... ...... <br /> 'D' Box ---- ....... Type t :Flitter Material ..........:.........Depth Filter Material ...._...............!.......................0 <br /> �. } <br /> Distance to nearest. Weil ........................ Foundation ................... Property tine ......................... r <br /> SEEPAGE PIT ( } Depth --------------- - Diameter N mbar .. :...._._..._..._.... ... Rock Filled Yes ❑ No ❑ d <br /> Water Table Depth ...Rock Size ...................... ---------- <br /> Prop.to nearest: Well .._..• • Pro . Line ...................... <br /> i Foundation - } <br /> REPAIR/ADDITION(Prev. Sanitation(Permit# ................... { <br /> Date ..... .... <br /> I t .� � �. , <br /> Septic Tank (Specify Requirerrrents) -----------............-�---- ..........................................�s � n -•..,..._....._........:..-_-,...-_. ..._.-•------._..:.._ <br /> Disposal Field (Specify Requirements) �......:.............. <br /> - -- - -- ------- - -- <br /> --- -- ---'.X. ............ -- <br /> ---------- -------------------------------------------------------- ----------------------------------.....................................:.......... ......:......... <br /> ........ <br /> _............ <br /> (Draw existing arid.required.addition-on,reverse side)- <br /> 1 hereby certify that I 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 licen- <br /> sed agents signature certifies the fallowing: <br /> "I certify that in the performance of the work-for which liis pe, df 1 11iis-issueshalt-not•empiay any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signed ---- Owner <br /> - - <br /> SY --- `----- =------ ---------------------- ----- Title _. ---------.- --------- <br /> (If oth han owner),' E <br /> DEPART NT USE ONLY <br /> APPLICATION ACCEPTED BY :. <br /> - ----. .----------------- ._...___..--- % .......... .a -..,..._ ' <br /> BUILDING PERMIT ISSUED ---•--f _.......---•----------------- ••-------•---:DATE --------------------------------------------- <br /> ADDITIONAL COMMENTS .-------------- ._.... - -----------------------•--•-------- -­----------- . ------------ <br /> .............--------------------__-•-------------- ------------ <br /> ------ ----------------•--------..._.._...._....---------._...__._.._ ........................... <br /> •- .r..._..._....._.. <br /> Final inspection by: .----- -----•--------- ----- --•.---._...----._..............._.__.._...Date _.2.- . 1.-.�s__.............. <br /> Eli 13 24 -68 Rev. 5M S,e�N JOAQVIN !OC HEALTH DISTRICT 8/7h 3M <br /> f _ <br />