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' .. FOR OFFICE USE: T <br /> APPLICATION <br /> FOR SANITATION PERMIT <br /> ....................................-.................... '. IComplete.in Tripticatel _....� .� _.._Fermi#No. `� =�-�•3 3 <br /> .. This Permit Expires II Year from Date Issued Date Issued .. <br /> -- <br /> Applicotion is hereby made to-the-San-;Joaquin-Isocal-Health-District-•fora permit`t construct and install the work herein <br /> described. This application is made in compliance w' <br /> } p County Ordinance No.-549 and existing Rules and <br /> Regulations: <br /> JOB ADDRESS/LOCATIONSU RACY <br /> - <br /> . ........ ... <br /> . t . .---..... <br /> Owner's Name .. st Phone:......... - .. . <br /> Address ... ..._...--- - ... _ <br /> = ....City ... ........ .. ...... ........................ . <br /> Contractor's Name •-• -. _., --.1 . - License # ..:... . <br /> . . - ----- •---..... Phone 'f � <br /> I !` i r <br /> Installation will serve.-. esidente Apartment House f] Commercial❑Troller Court <br /> Motel ❑Other .. <br /> i � <br /> ' Number of living units4 I .___.. Number of-bedroott�s--"' � ` <br /> -:::Garbage Grinder tot Size <br /> ' __••__ k .._..._.. ............' <br /> Wa#r apply: Public System and Warne `r t <br /> ................ . _.:......_ __.:...:"----.......-----.....Pr <br /> Nate <br /> Ch'itracter of soil to a depth of 3 feet: Sand Sil# Ga �! <br /> ❑ ❑ y ❑. Peat Q Sandy Loom ❑ Clay Loam j]. <br /> 1 Hardpan❑ Adobe❑ Fill Materiali € <br /> ► ..... if yes,tyl"............... ............ <br /> (Piot pian, showing size of lot, location of system in relation to wells, buildings, etc! must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank-or-see—page pit permitted If public sewer is available within 200 feet,) <br /> PAC TREATMENT [ ] SERC TANK ( M <br /> Size •_....¢..................• - •.,. Liquid Depth .......................... <br /> Capacity ---- _ pe -----= ... Mc(terlal... _._.. No. Compartments ..................... <br /> Distance.to nearest:'-Well ..!__.. <br /> No.'of Lines ------------ h g ------•---I-•....:.Foundation ...................... Prop. Line .................._... <br /> LEACHING LINE ( ] Length each line--�. • _ <br /> -------w� --•--............- - -- Total Length ....._._. <br /> 'D' Box .. ......... Type Filter Material ....................D�pth Filter Mf aterlal .............. ............................ I <br /> Distance to nearest: Well ------------------------ Foundatio ...............L ...... Property Line ........................ <br /> SEEPAGE PIT [ Depth ............ ...... Diameter _------------- Number -. <br /> --�.--.. -- .................I....... 'Rock Fitted Yes ❑ No �❑ <br /> Water Table Depth ............. ..................................)tock Size ._.... .............--.....---- i <br /> Distance to nearest. Well ---------•..............................foundation ..- -.....__..--.... . <br /> Pro p Line ....................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ............... ------ Date <br /> Septic Tank (Specify Requirementsl ­-------------------- .......... � .. ------.--• 1-._:.. .... ,...._. ._....... <br /> ..'Disposal Field (Specify Requirements) ............. ....... --•--- •-- [-•- <br /> ----------------- ---- ••--•- -----------•.---------------------•---- ----.-.-... <br /> 1 <br /> -y-.................. <br /> i------------------------------------------------- <br /> .......... <br /> ----------------------------------------- <br /> --- <br /> ------- ---- --------------—......................_ ..._ ---=---•-•---•-•---------- .............................._............................. <br /> (Draw existing and required addition on Nverse side) <br /> I hereby certify that 1 have prepared this application and #hot the work will be done in accordance with San .Joaquin b <br /> County Ordinances, State Laws, and Rules and Regulations af'the San Joaquin Local Hi3al&.District. Home owner or licen- <br /> sed agents signature certifies the fallowing: I i <br /> * "I certify that in the performance of the work for'which this permit is Issued, i shall. not employ any person in such manner <br /> ' <br /> Signed Wed become subject to Workmto an's Compensation laws of California." <br /> 9 ( - <br /> ---------- ••-=----=- Owner <br /> -'w1 --------- ----- <br /> By --•----- --------------�-----------...__ - ------ Owner <br /> _... C <br /> ••-- f <br /> (if other tha weer) ` <br /> FOR DEPARTMENT USE ONL: <br /> APPLICATION ACCEPTED BY,-.. <br /> --------t_...DATE ....U N�' :=1_.•-.------• .; <br /> BUILDING PERMIT ISSUED ... ... .........•..._ --.... DATE _... <br /> ADDITIONAL COMMENTS -._. �� <br /> • --I........ . <br /> . V'' "�' � ----•--•-------------•-- --•----..-•-----------•--•..--------....-•-------------•- <br /> ........................................... -� 4 <br /> ......................................... <br /> final Inspection Luys _.__. .._ Date.... Zw <br /> 1H 13 h 1-683 5M SAN JOAQUIN LOCAL HEALTH DISTRICT 5/711 <br />