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FOR OFFICE USE, �- ^ 1 ^ C)v I , I <br /> APPLICATION FOR SANITATION PERMIT <br /> iCompEete in Triplicate} Perrifil"No. .7 y-.� 1 <br /> ,. ;Ddt Issued .7..:............ <br /> ` ,:--- This Permit Expires 1 Year From Date Issued <br /> SJ��//��'ul•`� r+iGo ' X41 - <br /> Of <br /> AppTictat+on is hereby ma a tolthe San Joaquin Local Health District for'o permit to construct 'and instbll .the work herein <br /> described. This application is made in compliance with County; Ordinance No. 549 and existing Rules kind Regulations: <br /> JOB ADDRESS/LOCATION��` / �u.��1?{��' ..1t�.lri �t.;r' / lJ. 66 5� 7 ...........,_ .-.......... <br /> ?�Jn.'. - .....- �...... --'=..---•-Phone <br /> Owners Name-6. '/�.�/,. ./....z : ............................... <br /> Address, .. 1M -. ... G •c< .- .l ........ City .cam ...'... /r �....`.... .---.. ............................... <br /> -•- ... <br /> '� .. <br /> Contractor's Name . � �� . . "��r✓.���.. .. ...............:'...............License # .`�- .�.:'-.-. Phony} ............----•--........... <br /> installation will serve: Residence D A;- rtment House i] Commercial ❑Trailer Court ❑ <br /> Motel p Other ..... . .... ............. . ..... . ... <br /> -i T..... w' g - . ...........................b........-................................. <br /> 5 <br /> Number of living units:.. 7777 <br /> g Number of bedrooms ..... Garbo a Grinder�- Lot Size ---- ....••s private ❑ <br /> Character of soil to a de th of 3 feet: Sand Silt Cla`'7 Q Peat Sand loom Cloy I. <br /> Water Supply: Public S: stem an name . ...... .... :' <br /> P ❑ ❑ Y ❑ Y . ❑ Y oam ❑ <br /> " � <br /> Hardpan ❑ Adobe VIII Material ..... If yes,type .... - .-. . q. .._ j <br /> x <br /> (Piot plan, 'showing size of lot, location of system in relation to wells, buildings, etc. must be place8 on reverse side.) <br /> NEW INSTALLATION: (No septic tonic .or seepage pit permitted if public sewer is available within 200eet,) _ f <br /> Sizex .... <br /> PACKAGE TREATMENT SEPTIC TANK --------_ Liquid Dekth <br /> ....... . <br /> Capacity . �.�'" .. Type ..4c.c. �f`'Material-.": o Compartrr)ients <br /> I �- 4 ., <br /> Distance 10 nearest: Well :f! r ................Favndotion! Prop; Line .....-.-. --------- <br /> Total <br /> e <br /> LEACHING LINE [ No. of Lines - Length of each line o e �.--a <br /> g .`. J../.... Total Len$t)j 4 <br /> r1 <br /> 'D' Box . ?� Type Filter Material .. .:. ._._Depth Filter Material .--- .- . <br /> Distanceto nearest, Well ...... ..............:t_ Foundation Property Line � S <br /> Sl tit""PIT (� Depth ....... Diarnei er .A0.-, ..-/ 'Number �-i:. Rock F,i[leci Ye: No <br /> L% <br /> Water Table Depth ... ............?.--8 ------- ------._..Rock Size ......��..!" ............. i <br /> �� Distance to nearest. Well N./..............Foundation ....... Prop. Line 'S <br /> REPAIR/ADDITION(PreV..Sanitotion Permit# ......... .. . ...... ...... Date ..................................I <br /> Septic Tank (Specify Regvirements) . . : .......... . ....... <br /> Disposal. Field (Specify Requirements) .....................................................,.................... ........ ...... . ....... ... ............. <br /> ...... <br /> ........................ ._........ .... ... ........... .. . . <br /> (Draw existing and required bddition on reverse side) <br /> I 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. Haire owner or licem <br /> sed agents signature certifies the following: <br /> "I certify that In the peformance of the work for which this permit is issued, I shall not irnploy any perion.in such manner <br /> as to become subject ti''Workman's. Compensation laws of Calif4rn o." } <br /> Signed . .. .. ............ ... .... ............ �. t........ Owner <br /> .............. :. <br /> (if other Own owner) - <br /> 1.�rn.:= OR DEPA M 5 ONLY <br /> APPLICATION ACCEPTED BY : . -. DATE . . —,J.(1""..�.11...--..... <br /> i BUILDING PERMIT ISSUED . ... . .. .:. . ....................... ................... .. .............-DATE .........:......-........... <br /> ADDITIONAL COMMENTS .... .. ...................................... •-•---. -- ... .. ... ............ ........ <br /> ........ . ..... ..................... <br /> .......----•-. •--- ..... / �_. .... ....................... <br /> .......................... ........_....--...... ...... . <br /> Final Ins ection b A <br /> P Y� ------------- ----•----- . --..-. - ...-..-. --..-.�..-__..... .......-...-....... ........ .Date ......-........._. .>.........-...:....... <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT .. _. ... .. .... �- <br />