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APPLICATION FOR SANITATION PERMIT <br /> Permit No. ..7..- <br /> . 17 <br /> s (Complete In Triplfcatel <br /> .: 5 <br /> This Permit Expires 1 Year From Date Issued Date Issued "..... C... <br /> Application Is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> described. This application Is made In complianc with County Ordinance No. 549 and existing Rules and Regulations, <br /> JOB ADDRESSACCAT N .,�`�,L -� ................ C- ................._... <br /> .-..... .CENSUS TRACT ......................... <br /> Owner's Name .... . .......... r.. ....t_. ._....... ............ .... hone .................................... <br /> Address .............- .r . . �(r*�u ...- =r. ..............City - ' -4..---------•--------............. _ <br /> ..... <br /> Contractor's Name . ��-�� <br /> - --'-'=--- - •---- •.. ...............................................License# ��!53.�.-. Phone . ..............._.._......... <br /> installation will serves Residence OApartrnent House❑ Commercial❑Troller Court ❑ <br /> Motel ❑Other <br /> Number of living units:...., Number of bedrooms Garbage Grinder Lot Stze� � '.. 1� <br /> Water Supply: Public-System and name .........................................................-..__................................................. <br /> Pt'tvate,B[. <br /> Character of soil to a depth of 3 feet: Sand E3 Silt❑ Clay ❑ Peat❑ Sandy Loam fl Clay Loam ❑ <br /> Hardpan❑ Adobe K' Fill Material ............Ifyet#type............... ............ <br /> (Plot plan, showing size of lot, location of system In relation to wells, buildings, etc, must ba placed on reverse aid <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) , <br /> PACKAGE TREATMENT { } SEPTIC TAMC .................... Liquid DeptW...4/..--.............. <br /> ,p <br /> Capactty/d.......... Type ( . Material. 1 ...... Na. Compartments ...c :........... <br /> Distance to nearest: Well" p p. <br /> ...... ._.. �-•-----------------Found tion .__u..�.--_---.. Pro Line ...- ------.. <br /> EACHING LINE No. of Lines ...._. ............ Length of each line..: ................... Total Length ....� ?........... . <br /> 'D' Box -f " Type Filter Material .5f.A�'Af.«:..Depth Filter Material ... . .......................... <br /> Distance tonearest: Well ........................ Foundation ........................ Property Line ....................... <br /> M l <br /> SEEPAGE PIT [+t- Depth ., 4........... Diameto0c............. Number ..........�........... Rock Filled Yes ( No <br /> Water Table Depth ..... ......`....... ... ....................Rock Size ................................ <br /> Distance to nearestg Well ---Ikele...........................Foundation .......... Prop. Line .............. <br /> REPAIR/ADDITION[Prov. Sanitation Permit# ............................................ Date .................................. <br /> y <br /> SepticTank (Specify Requirements) ......................................... .............--------.................,...................................._................. <br /> Disposal Field (Specify Requirements) .............................•-----..._.....................................................................................---...... <br /> . ..........•............................................................................................----•--.._.._..............................._._.._...--••--------.....................•_..... <br /> (Draw existing and required addition on reverse sidel <br /> I hereby certify that t 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 Son Joaquin Local Health District. Home owner or licen. <br /> sed agents signature certifies the following: <br /> "I certify that n the performance of the work for which this permit is Issued, I shall not employ any person In such manner <br /> as to bec �ub' t-ta Wock an')-Compensalt . ws f Cali ornia& <br /> r <br /> ­anec <br /> er <br /> BY ...�y{ *= ./frr. .................. .•-----. Witte .-.. ..... d.�C rte........... <br /> (If other than owner <br /> Fa DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY Vis.. .. -,. ............................ DATE7b.... <br /> BUILDING PERMIT ISSUED .................................DATE-...................................... <br /> ..... <br /> ADDITIONALCOMMENTS .................................................................... ................I..................... ............................I................... <br /> .----.---.......... .........................._.................... ....... ..........--•---........................... <br /> ... .......... ----- .... . <br /> Final Inspection b ............Date ... . ..-�-. <br /> 1✓H 13 21, 1-60 11ov. q4 SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3m <br />