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f , FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicatef <br /> � ..... ............................................ � _ _ . _ Permit Na. _.......---•---•-•--• <br /> This Permit Expires 1 Year From Date Issued Date Issued ...............7S.. <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 mad•e in compliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION ,.. �J 1 0j/fQ/jJ <br /> Owner' �-• -- .....CE ........... _..-..._.. <br /> s Name _ .. ......E�-�-/� �C1.f/ ._ <br /> US TRACT .__.. <br /> i Address ............. �! ......._...••-• <br /> Phone <br /> k ............... -_.... City �a.?/ C,�• <br /> Contractor's Name <br /> ----•---•-----_-_---.License # A`?!6.T-or Phone .IP73. <br /> Installation will serve: Residence Apartment Housefl Commercial❑'!'railer Court 0 <br /> Motel []Other.,-.. <br /> Number of living units:----- .._. Number of bedrooms .........Garbage Grinder ............ Lot Size ...-•i5 _� <br /> Water Supply: ..... .............::.... <br /> pp Y• Public System and name .............. <br /> ------------------------ <br /> ---------••-- -----... <br /> _.......... <br /> ...-- ...Private <br /> Character of soil to a depth of 3 feet: Sand b Silt 0 Clay ❑ Peat❑ Sand Loam <br /> Y ,•a_ .,,clay.Loam ❑ {` <br /> Hardpan ❑ Adobe❑ Fill Material <br /> ...... If yes,type ............... ............ <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.} <br /> NEW INSTALLATION: ( <br /> No septic tank or seepage pit permitted if public sewer Is available within 200 feet,l <br /> PACKAGE TREATMENT I ) SEPTIC TAMC <br /> r P...m. ! — - w__.-r —. Size.._.vtw�__ '.�i_.�./— r---_-b--••.-.-.-.-.- <br /> ............ <br /> Liquid Depth � .......... <br /> r . <br /> Material ----- <br /> ------ Type .._-_ <br /> --_ <br /> _ <br /> • :Na.Compartments <br /> Distance.to nearest.• Well <br /> . ...................Foundation .I�. Prop. Line .. ��-`4? ....[ <br /> LEACHING LINE [ ] No. of Lines _. <br /> A ft <br /> Len th of each line._�j"D... .............. Total Len Length <br /> D' Box _.- Type Filter Material .7 .y `Depth Filter Material . ., 00 <br /> ,1' <br /> Distaste to nearest: Well <br /> ...:••-.... Foundation .._. Property LineSEEPAGE PIT Depth <br /> r ....:-: AA <br /> . -- ------... <br /> Diameter ­_- Number Rw.wkI=i I d Ye <br /> s.fj No C3 <br /> Water Table;Depth <br /> ...............'-- --••----- ._Rock Size .......... <br /> F Distance tonearest: Well ................ Foundation --- ................ prop. Line ...........•.......... <br /> e <br /> �REP.�AIR/ADITIO..,N_(Prev._Sanitation._Perrit #____________._..-----•--------••-•-----,.... Date � I <br /> Septic Tank (Specify Requirements) ------I.............. <br /> Dispos�ILField (Specify Requirements) --•--•-•__,-•-,=••- =.-............... <br /> � <br /> ------------ ................................... <br /> -----------•-------------------- ------------------------------------•-•-------------- -------•... :_--.... :._. <br /> ` -{Draw existing and required addition ori reverse side), # <br /> I hereby certify that I have prepared this application and that the work rvli! }.be.clone In accordance with Son .Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Healih;Districf. Home owner or licew <br /> sed agents signature certifies the following: d <br /> "! certify that in the performance of the work far'which this permit is issued! shnfi not ee» io an <br /> as.to become sub(ect Wyrkman' Compensation laws of California." -�~ � P y y,Person in such manner <br /> z <br /> Signed --- �- <br /> - <br /> Owser <br /> --------------- •--------- Title ---....-------- - <br /> lif other than owned <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY <br /> BUILDING PERMIT ISSUED __ __,.` ------------ .............----- - ------------. DATE -_ :: <br /> DITlONAL COMMENTS ---------•----...L--•-•-------- --- .................•--------..._ <br /> DATE ...... . . . ------................. <br /> --------------•--------. •--................-----•---•....,_......... ---•------- <br /> -------------------...-- <br /> ------- ¢ • -------- <br /> •--... <br /> Asa Inspection by: _. - ._.�- -- <br /> •---------•---------•- -•--......._•---• ....... ".'- .._..... <br /> 1;'1i 13 2 -6t3 ---.....---- ••. •-----.Date .... <br /> 5N SAN JOAQUIN LOCAL HEALTH DISTRICTw <br /> 8/7h 3M <br />