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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Triplicate) <br /> Date issued ............. <br />...... ..... .......................... ........... This Permit Expires 1 Year From Date Issued <br /> ............. <br /> it to construct 6nd <br /> - - - -• - -- -- made to the San Joaquin Local Health District, forme No. 549 and existing Rules tand Regulation!;- 1 <br /> all the work herein <br /> Application ;s hereby Bance with County ordinance <br /> lication �s made in comp <br /> described. This app i CENSUS TRACT <br /> °' '02._ 1 -w _........ <br /> )77 <br /> JOB ADDRESS/LOCATIO e <br /> Phone <br /> G,e �'�:�J <br /> ------•-- <br /> ..................... <br /> Owner's Name -.....-._ a•�/�_- -�r�.�.__..._.... <br /> --- -•. ............ City .� --- - <br /> q .._.....- . o.._. - <br /> Address �•-�--3.., . � � ..License � o�-.�'j/-%'`I Phone <br /> Contractor's Name . ---. <br /> Installation will serve: Residence E] Apartment House Commercial,_ Prader Court '❑ <br /> Motel ❑Other -._...--. ....---•....__-----­------ <br /> --• ----- .�"� <br /> Nu -_Garbage Grinder .4_ - Lot Size - IP.- - +, <br /> • Number of, be rooms <br /> Number of living un+is:."'� d name - .-----•C..........oam....Private' <br /> Public System an .....-• •- <br /> Water Supply: Y - - -• Peat❑ Sandy Loam El <br /> L <br /> Character of soil to a depth of 3 feet: Sand❑ Silt ] Clay ❑ <br /> yes, <br /> l --�� ..-.-- - • I es, p � � . <br /> I Hardpan ❑ Adobe Fill Material .. <br />} Ian showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> } {Plot p <br /> F NEW INSTALLATION: (No septic tank or seepage p��t permit�ed�public sewer is available within 200 feet,) <br /> ................... Liquid Depth ----....---....__...--•_.. <br /> SEPTIC TANK[ I /S +ze---- ------------------ � <br /> PACKAGE TREATMENT ( ] ••-•-••-•=-••-•---. <br /> Capacity .. .. ... ......... Type --------•----,-.---- Material----._..._;-: ......._ No. Compartments � <br /> I Distance to nearest: Well - - -------- <br /> -----------------Foundation ................... .. Prop. Line .....__.�............ J. <br /> a_. -_._ `..-. Length of each line._...-- Total Length- .��a_-._.-----..�:4 <br /> _., <br /> [ _LEACHING LINE.. No. of Lines _. - <br /> Type Filter Material __4 ----Depth filter•Material _.-I�1- •--•..._.__f......__.._. <br /> �. D' Box /... yp i <br /> • ` �Q ..._- Property line ---�---•-. ....----• <br /> Foundation <br /> __Distance to nearest: Well -. -- Rock Filled Yes' ( '- No ❑�' <br /> Depth �•�-• --��- Diameter <br /> . �._ Number t :. <br /> SEEPAGE! <br /> EEPAGE PIT Y p 3 <br /> `-, -••-----•----•---Rock Size ----v�-�---•---�•----:--- •- �./- Gd <br /> Water Tcible Depth - ��--- •-•' / <br /> i Foundation -: 0.._..--.. Prop. Line .. .-___----_------ <br /> Distance to nearest: Well - ) <br /> Date ---- ---•-------=.:__-------- <br /> [ REPAIR/ADDITION(Prev. Sanitation Permit# -------- ....... ---.-..-..---.• <br /> ` , <br /> I Septic Tank (Specify Requirements) _ ..- ........... - - .:- ..- . --------------- <br /> Disposal <br /> Disposal Field (specify Requirements) ..-_ <br /> ................• <br /> .... .................. <br /> .... ............ g __....._ - .. <br /> I (Draw existing and re uired addition on reverse side) <br /> no in, <br /> h Son Joaquin <br /> I hereby certify that f have prepared this application and th f the San Joaquin L6461Health District.accordance t <br /> the work will be Homeoner or [icon <br /> County Ordinances, State Laws, and Rules and Regulations o <br /> sed agents signature certifies the following: erson in such manner <br /> "I certify that in the performance of the work for which this permit is issued, f shad not *n�pley any p <br /> as to become subject to Workman,s Compensation laws of California." <br /> Owner <br /> l Signed .:.. .... ...... <br /> _.-:�_..._----• -•---- Title <br /> By <br /> (if other than owner) <br /> FOR DEPARTMENT USE ONLY <br /> DATE <br /> DATE - <br /> APPLICATION ACCEPTED BY -... - - __..--.._- ....----•..:............• <br /> BUILDING PERMIT ISSUED . -- ... -- -- ------------- _.-_..... ...._--•--- .__...._..-.... ....- ' <br /> ADDITIONAL COMMENTS <br /> I <br /> ........ ............ .... --.{ - ---•---------•...-- ------ ..__..__..._.. <br /> -•-- <br /> -- ----- _----- ------------•- / <br /> ...... <br /> G ...X�7------------�/�------- <br /> --- <br /> Final Inspection by: ---- <br /> ..,.•,. :�A•N -JCtA. : IN LOCAL HEALTH DISTRICT <br /> VI'7/ 3 ,K <br />