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FOR OFFICE USE: , APPLICATION FOR SANITATION PERMIT <br /> �. •.. Permit No. ........ <br /> :L••......` <br /> I (Complete in Triplicate) .5 :�CJ�Y, <br /> Date Issued .. •- <br /> ....... .............................. . . <br /> This Permit Expires 1 Year From Date Issued <br /> ....... .. .. <br /> in <br /> strict <br /> rmit to construct and <br /> the work herei <br /> Application is hereby made torrhe San Joaquin Local n compliance wih Health Di 0 dinarnce No. 549 and existing Rulestand Regulations: <br /> described. This application is <br /> ode:1 - - .. .... <br /> .� ...41-1-,?" -..-..--_ CENSUS <br /> 5 TRAr ................. <br /> JOB ADDRESS/LOCATION .. .L- :-...�f�... _ - - <br /> .�. � - <br /> Owner's Name .... <br /> -- { ....... ....... City <br /> Address ._._-.�/�- -- -- <br /> t S.� t Phone <br /> ' License #1 -� <br /> Contractor's Name <br /> Installation will serve: Residence, Apartment House[]Commercial ❑Trailer Court 0 <br /> s <br /> Motel ❑Other .......... .. .... ._:. .... -••---• . <br /> Q / .�........... .. .. <br /> Number of living units:..-(----.- Number of bedrooms -.Z•--- <br /> Garbage Grinder ,,1l1�_-• Lot'Size� - ---,x-- �. <br /> Water Su l uwl System and name --..-----•- ----•------ ------ ------ •---........-----....------••---......---•--..._ <br /> Private ❑ <br /> pp Y� � � ----------- --- • -Clay Loam <br />`` Character of soil to a depth of 3 feet: Sand'❑ .Silt C3Clay ❑ Peat❑ Sandy.Loam fl Y <br /> Hardpan ❑ Adobe: " Fill Material if Vis,type <br /> (Plot plan, showing size of lot, location of. system in relation to wells, <br /> buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> ,I . Liquid Depth --••...............•. <br /> PACKAGE TREATMENT [ ] <br /> SEPTIC TANK{ ]ISize----------_---_- q P <br /> Capacity ......----••---•---- Type ... -------_------- <br /> Material----------------- -- No. Compartments <br /> I F.oun orlon Arop'Line'...............:...... <br /> Distance to nearest. Well <br /> lf"� —' <br /> LEACHING LINE [ ] nes -------------------- <br /> ------ Length of each line..._..-------•- •Total Length -----••--.......--•--...---• <br /> No. o <br /> __.De Depth Filter Material ....-------••---....... <br /> 'D' Box -------- TYPe Filter Material -_-----•----.... P <br /> - <br /> Pro Line ........................ <br /> Distance to nearest: Well .....................-.•:•-Foundation^*---:==-�--•••-------- p�Y� <br /> SEEPAGE PIT [ ) Depth <br /> ................. Diameter Number ..__•---------••-..----•---- Rock Filled Yes E3 No C2 <br /> lRock Size .....................----------- <br /> Water Table Depth -..---_--•---- ••........ , <br /> Foundations` . :: :---- Prop. Line ...................... <br /> to nearest: Well <br /> Date <br /> ISanitation Permit# ------------ ..... ) <br /> REPAIR/ADDITION(Prev.{ -----•------------------•--------•--------- <br /> .1 <br /> Septic Tank (Specify Requirements) ........................--•=•- 33 <br /> � .... : T ._ . -- ._ / <br /> Disposal Field (Specify Requirements) ..............� -- <br /> ..............-........---------------------------------------------------------------------------------------------------------------------------- <br /> - --------••-------- •---------------••----...---------------••-- -----•------.....------••----....... ......................................... <br /> t � (Draw existing and 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 llcen- <br /> sed agents signature certifies the following: <br /> "1 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 /> Signed -- .................. <br /> Owner <br /> 9 --•AVG_. <br /> ------------ ....... <br /> ........ Title Title ..�i�.�.Tib' -- -- -.......................... <br /> (1f other tha wner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED ldY .. - -•• " ....................... <br /> DATE :_.�_ ..�.. �H..----•....---•-- <br /> ........--- DATE <br /> --•-----_.................... <br /> BUILDING PERMIT ISSUED ----------------------------------------------••---------- ...... <br /> I ADDITIONAL COM ..................................... _............ <br /> -511-fti ...... Date ............ <br /> ................ ....... .... <br /> :.:.. <br /> A Final Inspection by: .._ <br /> ' t /,� SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> `iJ�4 7/723-M <br />