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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT 7 - a 3 <br /> r <br /> Permit No. :.....:....... . <br /> -•--• (Complete in Triplicate) <br /> Date issued S 2!e <br /> This Permit Expires 1 Year From Date issued <br /> ...............................................:..... . <br />.... all the <br /> mit to constr�ct an <br /> Application is hereby made to the San Joaquin Local tHlea u District <br /> rnce No. 549 and existing Rules tand Regulations: <br /> rein <br /> App ' <br /> described. This application is made in compliance <br /> / meg[ .,.CENSUS TRACT ............ <br /> .G... <br /> JOB ADDRESSACICATION ....... . <br /> Phone .L ................... .. <br /> Ci <br /> Owner's Name ..._... <br /> tY ... <br /> Address �d r <br /> 9 . Phone 1K..... ....�f <br /> ...license # .�•/��.../••- <br /> Contractor's Name -------- - <br /> Installation will serve: Residence[yjl(portment:House fl Commercial oTraller Court ] <br /> Motel []Other ....................... .% <br /> t Size ... ........... <br /> / Garbo a Grinder . ••---•••"-'"' <br /> Number of living units.-..-/.... Number of bedrooms .•.. ...___. ' <br /> ..................Private ❑ <br /> - fl Y <br /> r Water Supply: Public System an name --------------- .................. Sandy Loam Clay Loam ❑ <br /> Character of soil to a depth of 3 feet: Sand ] Silt(] Glay [] Peat .. <br /> if es <br /> ,type <br /> Hardpan [ Adobe Material . <br />` d <br /> {Plot plan, showing size of lot, location of system in relation to wells, <br /> buildings, etc. must �e placed on reverse $1 e.) <br /> k NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> . ,� y <br /> // � •---•••--.... Liquid Depth .........................._ <br /> SEPTIC TANK{ Size. ..-1=-.. � <br /> PACKAGE TREATMENT [ ] / Compartments .. <br /> �/i�.�. Material..L" •-•- No. . -.... <br />�. . =„r. , <br /> _r Capacity- _Q Type ` <br /> Foundation .---;,1 <br /> ......... Prop. Lire - ��`��'�'� <br /> Distance to nearest: Well .. - ....... • r <br /> Total Length ---10.4-.....---... <br /> LEACHING LINE [W' No. of Lines ----- - Length--�of each line..- ri <br /> D' Box --------.. Type Filter Material ....'ilC�?oI__Depth Filter Material ......� ........ <br /> Foundation ... ..�d•I Property Line ..� .��f""' <br /> f Dist n e to nearest: Well es -� ,, � No iQ <br /> Diameter ._ _ ...... Number _._._.. <br /> f Rock Filled Yes <br /> SEEPAGE PIT [� Depth '� /� <br /> S a Rock Size ...C;7 ..1 -------- <br /> Water Tobie"Depth -•••-- •-------••--.. . r <br /> ' - <br /> Distance to nearest. Well --.--••--• -•-•• <br /> ...........Foundation <br /> ..._ :..._... Prop. tine --•••• <br /> f <br /> DateR-----_... ................ <br /> REPAIR/ADDITION(Prev. Sanitation Perm•t# - <br /> .. } <br /> l ....... <br /> Septic Tankr(Specify;Requirements). - - <br /> � <br /> Disposal Field (Specify Re ui€amen s ------------• <br /> ------ ------- ------ <br /> --------- --------- --- --- <br /> ---- -------- _ <br /> (Draw existing and required addition on reverseside) <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 Saar Joaquin Local Health,,District. HOMO Owner or licen- <br /> sed agents signature certifies the following: to person in such manner <br /> "I certify that in the performance of the work for which this permit is issued, 1 shall not employ any <br /> i as to beco bje t to Wor an's Cqmpensatlon laws of California." <br /> Owner <br /> Signed -- _- - ' - :Title'_.._ <br /> _... <br /> (If other than ow 0 <br /> FOR DEPARTMENT USE ONLY <br /> -------• ----------------•- - -------- ------- -------- --------� DATE _.-.....`:.lir?----�-------- <br /> A <br /> - - ---._.- - <br /> APPLICATION ACCEPTED BY -- ------ -- --- - ' <br /> AT <br /> BUILDING PERMIT ISSUED -. -4- ,r <br /> ADblTIONAL COMMENTS �i. .� - 4 ,�cc�lf�` r ��».r ------- ------------•• <br /> - ..................................... <br /> - _ _ <br /> ate . <br /> Final Inspection by: .------. ...•E� <br /> EH 13 .24 1--68 Rev. 5MSAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />