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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. _____._.__-_.__.____ <br /> ---------=----------------------------------------------- <br /> ------------ ---------_____.____.__-__-_-_______-__.____ T Permit Expires ] Year From Date Issued <br /> Date Issued <br /> Application is hereby made to the San Joaquin ocal Health District for a permit to construct and install the work herein <br /> described, Thisapplication is made in complian e w.'t`hounty Ordinance No. 549 and existing Rules and Regulations: <br /> JOB AQDRESS/LOC ION .___- � _ �? <br /> . � -------------- --------CENSUS TRACT ------d ((.------ <br /> Owner's Name ---� ' (/,,�� 4/247_E___ Phone IIIAddress -- -----� ------4--------- � ��- --------__. City ---- C�} �Z����-------------------- <br /> Contractor's Na a ._ E -------- jV �------------------------------------License # --------- , ---- Phone ------------ ----------------- <br /> Installation will terve: Residence E�l rpartment House°❑ Commercial ❑Trailer Court ;[] <br /> Mote! ---- <br /> Number of fivin� uri�ts:__. ------ N r of b drooms _ _._ rpi - Lo Si e --_ Cigr -� <br /> Water Supply: Public System and a _----_ -_ 1", <br /> pp Y Y ----------------------Private <br /> Character of soil to a epth of 3 fe iY Sand' Silt p Clay ❑ Peat❑ _Sandy Loa Clay Loam <br /> ardpan � Adobe ❑ Fill Ma eriR If yes,typ _________________�_1 34 C�-__ <br /> (Plot plan, showing ize of lot, Iota •on of system in relation to wells, uildings, etc. must be We44 on reverse side.) <br /> NEW INSTALLATt'ON: ( o septic a or seepage pit permitted if public sewer is available within 2 eet,) <br /> PACKAGE TREAT E T [ SEPTI TA K' Size-_--f--- � _x____ - --__-_ Liquid Depth _____ _____ ___ _- }/ <br /> C pacity - __ TypeO_uPi-_E9 Material__ /YGKNjjot Compartments ----��- = <br /> Di tante t near Well ____-_ __4-------------Foundation ------- Prop. Line <br /> f-_-�__ ._� <br /> LEACHING LINE [' N . of Lin s ------- _ ------------ Length of each line---- --- Total Length -__!-_�_e-�___.. --_______ <br /> D Box . _ Ty Filter Material _ _ _ __Depth Filter Material -------- r __________------------ <br /> Di! <br /> ____ ______ <br /> 1 Di tante to ne r�st: 11 _�_ / - - r <br /> Foundation --�t✓---------------- Property Line -- ---- ---- <br /> SEEPAGE PIT f De th 4 r <br /> !�f -- ---------- er ;---------�_ Number ------�------------�---�- Rock Filled Yes �1r No ❑ � <br /> W ter Tabl Depth -___-_ �- f_ y f <br /> Rock Size X, <br /> Dis ante to nearest: Well - ------ ---------Foundati �� <br /> ---1�-------- -- Prop. Line --�-------------- <br /> REPAIR/ADDITIO , L. Scnitation ermit# --------I _ _______________________________ Date -----_-_----___________-__---_ <br /> SepticTank (SpIfy Req irement ) -------------------------- -- ------------------------------------------------------------------------------------------------------------ <br /> Disposal Field I&.ecify a ire ents) ------------------------------------- -- ----------------------------------ti---- --s <br /> { <br /> 1 <br /> -ic - ------ AVX '--c--\-- ----------------------- <br /> ---- ------- ------------------------------------------------------------------------------- -- -T� <br /> - ------------------------------ <br /> i e �N Draw existing and required addition on reverse side) <br /> 1 hereby certify that I hav mi a this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State vim, Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signatire certifi s the I wing: <br /> "I certif t in 'e erF tance of he work for which this permit is issued, I shall not employ any person in such manner <br /> as to omejI ct t W km s ompensati,on laws of California." <br /> Signd . -- -- ---- --- ---- ----- - r ---- -------- ------- ---------------- wner_ <br /> TitfBy ------------ ---------- ---- ---- ---- -------- ---- --- - e _ <br /> - <br /> {If o he than wner) <br /> C <br /> FOR D ARTMENT U ONLY <br /> --- <br /> APPLICATION AC EP ED B - - - <br /> BUILDING PERMIt IS UEQ -= ------------------------------------------------- = n T� ---- -- -- <br /> ADDITIONAL. CO M NTS -- ----- - ------------------ <br /> --------------------- -- -------- --------------------- --- ------- ----- ------------------------- ---------------------- - .- <br /> ---- ------- <br /> 0� -- --------a------�F t� ---------------- --- <br /> ------------------ ----------------- ---- - ------ - ----- - - - -------------------------------------- <br /> - --------- --------- ---- ------- <br /> Final Inspection - 1 ------ ---- ------- a e - -------- ------ <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />