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a; •-e <br /> FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> 1»--f Permit No. <br /> —(Complete in Triplicate)- , <br /> -------------------------------------------------------- <br /> - .�'".—'\ t ' <br /> I I *. ;.� 1 Date Issued <br /> Th�serm <br /> ,Pit Expires 1 Year From'Date Issued f <br /> Application is hereby made to the San doagoin toceAe'alth District for aj permit to construct and install the work herein <br /> described. This application is'madi in`,compliance with County'Ordinance" No�549, and existing Rules and Regulations: <br /> K S ---CENSUS TRACT ------ -------•-------- <br /> ` i - - j......--_. <br /> JOB ADDRESS/LOCATION .--- r2�-- -�`�-- -�- - -L"-��_01_�--•-- �,_---�-•- ��--------------------Phone --C��'-����_�T_�-.�7--•---- <br /> Owners Name - �- <br /> ,r: , I <br /> 2SS -1 L ^� 5c6_Lo-- -------------------------------- ----------- <br /> Address ----- ss 1 <br /> Contractor's Name ---- ' ---.License # --------- <br /> ---�-=----- Phone ---------------------------•-- <br /> ' i <br /> Installation will serve: -----Residence-{]Apartment House-E] Com"Mercia) ❑Traile`r Court ',❑ <br /> Motel ❑Other - <br /> �r -. <br /> Number of living units- `�---_- Number of bedrooms'-3--_--Garbage Grinder _ O---- Lot Size <br /> { - -----------------Private <br /> Water Supply: Public System and � '� 'v e <br /> It <br /> Hume --- ------ ' ----- -- ••--------- ------ - ------------------:- y ❑ ■/ <br /> } F <br /> Character of'soil to a depth of 3 feet: Sand ❑ Silt❑ Clay-❑• Peak❑ Sandy t am U Cla Loam l+Fy][ <br /> '� In <br /> ❑ Adobe ❑ Fill Materidl _ . -�---- If,yes, type ------ ------ --: -- <br /> rc <br /> (Plot plan, showing size of lot;lo�ation of system relation to wellsbuildingsi lec. must berplaced on reverse side.) <br /> NEW INSTALLATION: {No septicliank or seepag' p-pit-perrxiitted;if�public sewer is dvailable within 200 feet) <br /> qY .r•- <br /> PACKAGE TREATMENT [ I SCPTIC TANK [ "rSize` X�Q-, ,,. --- - Liqurd=Depfih'-_ .: ---------- <br /> C parity _j DO Type f€F)91a--- Mater[al- _ <br /> No. Compar#ments __�-- <br /> 'I tanearest: Well <br /> _--__-.-_-.-------�.--'-- ��'ar Fun <br /> d�ati1oFi <br /> n�/1 <br /> -- ---Q <br /> Prop. <br /> p.�L'i�n.e -•-- <br /> -� <br /> = <br /> _- <br /> Li <br /> LEACHING LINE [t}�Noof Lines ----- <br /> l --Le_ng.tiof eaafi--iineo -- Total Length Ao---- <br /> ,D' Bo„ �. Type Filter Materia p_- ptFer� Material' . -j1--- -- ------ <br /> P= <br /> Di'stance to nearest: Well Foundation an ----- ro erty Line --------- -------------- <br /> Number' <br /> -- --•••_ <br /> Number' Rock Filled Yes Z?�No <br /> E PIT � Depth. = -.SEEPAG _ Diameter <br /> �1�' - <br />' _..Water Table�'Depth ------------=/, -_---------------------------- ----------- <br /> _ <br /> �., ,f Prop. Line <br /> Distance,to�nearest: Well _______________I-_Q-_ ___.-•,Foundation __ <br /> 1 <br /> ------------ ------ Date ------------ }---------------) <br /> REPAIR/ADDITION.{Prev. Sanitation Permit#., _ <br /> -----__. - -_- <br /> Septic Tank (Specify Requirements)••-.----------------- - -----------------------------------------------------' . ----------------------- <br /> :. <br /> f Disposal Field (Specifq'Requirements) ----- - ---(I.,G.-•----- -------- .� <br /> -------=------^r- ------I__--'- ------------------------------------------------------ <br /> ----------------------------------------------- <br /> --------- ------------- - - - <br /> -z �.--------------------- - = = = <br /> \jDraw existing and required addition on reversesi`ae) I I\- <br /> ---------- <br /> y I hereby certify that 1 have preparedTthis. application and kthat the work will be done'in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules' and Regulationsfbf the San Joaquin Local Health District. Homeowner or licen- <br /> sed agents signature°certifies the following:' ti .Z .� <br /> "1 certify that in the performance of,the work for which this permit is issued,-;l,shall not employ any personln'such manner <br /> as to become subject to Workman's kompensa ion laws of California." F .V <br /> t Sig`ned - -0------------------- <br /> Owner. <br /> wner.-------------- ---- = i <br /> - ;By ------y> ------- --------- <br /> N. 4 {If other than owner} <br /> FORDEPARTMENT USE-ONLY <br /> . s rµ�` '-- _DATE �r _'_�F---------------- <br /> APPLICATION ACCEPTED BY ._- 1 r 1! <br /> BUILDING PERMIT ISSUED -- DATE <br /> CSU _ <br /> ------------ <br /> ADDIT�IONAI----COMMENTS--_— � �r <br /> r = <br /> __ _ __ <br /> - - _ t = _. Y ----------------- <br /> - --- <br /> - --------- ---- ---------------- <br /> --- ---- - -------------- /. _ _ <br /> ------------ ------------J T - -------- <br /> ------------ <br /> ------ <br /> -- ------ - <br /> Final Insp tt�on�by: - - '- - - - - - -- ------- ----- <br /> ---- ---- Date <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> f <br /> �. E. H. 9 1-'6B Rev. 5M <br />