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f FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERMIT s <br /> ---•------ <br /> { , 0Aplete init Ti^ipf6sa#e1 � . . ..... <br /> ----------------------------------- <br /> --------- ------ T <br /> ... This Permit Expires i Year From Data issued Date issued`: ...:: 6 <br /> Application is hereby made to flie.Son 1bWOM'Local'Hecoltif-Disttiet-for a permit to construct and Install the work herein <br /> ' described. This application is made//in compliance with County Ordinance No. 549 and existing Rules and Regulationsr <br /> JOB ADDRESS/LOCATION ...... l. . .. ........ �._... .`'?` 'S ....................... f <br /> ......CENSUS TRACT .......................... <br /> Owner's Name .... . '._ .. _.. .. ;........................ ..Phone ..'...f........................... <br /> .. <br /> Address ..._......_� . __....-.. City ............. ............... ..... <br /> .......... <br /> _... _R ....__-..._•__-......'.�.•-... ...._•_-•__..... - <br /> Contractor's Name ,%C..__. K. .cense # <br /> Installation will serve: Resicl nce Apartment House C❑ Commercial ]Trailer Court 0 : <br /> Motel ❑Other ------Ii .de <br /> u <br /> Number of living units:_.__... Number of bedroo s . . -Garbage Grinder Lot Size' ... <br /> Water Supply: Public System and norne -. <br /> � . .. .. :..4!!r ......-- --.................................. ............Private ❑ <br /> Character of soil to a depth of 3 feet: ' Sand b Silt.❑, Clay ❑ Peat❑ Sandy Loam ❑ ..Clay Loam p <br /> { <br /> ' . Hardpan E] Adobe ' .Fill-Mloterial .....=...'If yes,type <br /> {Plot plan, showing size of lot,;location of system in relation to wells, buildings,'etc, Must beplaced on reverse side.) <br /> i NEW:INSTALLATION: (No septic tank or seepage pit permitted if public sewer is ovoilable;w�thin 200 feet,) <br /> PACKAGE TREATMENTSize. <br /> SEPTIC TANK . .. ~� r <br /> { l �_. �� ��.�.�� ' Liquid Depth ---°�►-•--•.............. <br /> Capacity/ 1,� .. =-�Xype �td�, Material. � No,Compartments ! - <br /> ©y <br /> Distance to nearest: Well .- �------ ..Foundation�A-e.....!.._t. Prop. Line .` �......---L11 <br /> Length of a line....:_,1 ....... Total I;ength f 1 6 <br /> LEACHING LINE � No. of Lines ..___.�.._...._.._ . ----------------, <br /> 16 <br /> 'D' Box :.l� T �i <br /> ype Filter Materlol .-- - -- _ --.Depth Filter Material ../r�-.....s.:��.................... rr <br /> Distance,to nearest: Well . .._ -- l+asandation,^ _t.:.:.-:.-_Propert) Line .............. <br /> SEEPAGE PIT Depth Diameter d <br /> - _--- -- Number _...__:. ---- Rock Filled Yes No C] <br /> rr , <br /> Water Table Depth ........ ...A..--................. ... ....:...Rock Size -•-CZ...............•.......... <br /> Distance to nearest: Well . <br /> ;._..* Foundatiio'n -_. ......_." . Prop. Line ...................... <br /> .............. <br /> ## <br /> REPAIR/ADDITION(Prev. Sanitation Permit ..___. .•..... .... <br /> ..... ..... _. Date _ti......................_....`..) <br /> Septic Tank {Specify Requirem6nts# . <br /> Disposal Field (Specify Requlydme-its) -----•.............................................................. <br /> ..._......--•-- ---•- <br /> ------. -------------­- ---------------------------------- ---------- <br /> ----------------------------------------------- -----------------------. <br /> -- ... ......:................................. <br /> } iDraw existingand required addition on reverse side) r <br /> I hereby certify that 1 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 San Joaquin Local Health District. Home owner or licen• <br /> sed agents signature certifies the'following; _ <br /> j "1 certify that In the performance of the�worli for whlcVt'hispermit is issued, 1,shall not employ any person In such manner <br /> as to become subject to Workman's Compensation41aws of California." <br /> Signed:..................... ' F Owner <br /> B --- <br /> ... • ----- .Title ...................... . ..........................` . <br /> Y ... <br /> (If other than owner) <br /> I F `i IVEPARTMENT USE ONLY. s <br /> APPLICATION ACCEPTED BY _. <br /> - - ------- - ----------- ----�-- -----J-----�..---•-•----............-------� DATE...-- �=-�-`--7-�--------- <br /> ADTI NA COMMENTS ..._ .: ... ---....¢.........................................._...._........._......_......---..t ............................ s <br /> . ..... -•---- ............. <br /> BUILDING PERMIT ISSUED ... .:..a.-.... .......... ... . .. ..... ...... <br /> .-•• ... <br /> P�� <br /> .....................�-----•--- --- ... -- . ---- ------------------- ------._ `..... .......... --.....---..... <br /> ... .. "'�`•... ... . . <br /> r <br /> L .......: t c , x a> <br /> w <br /> final inspection by::. ''_ , �'�.... :'-._. .. Date.. <br /> Eli 13 2h 1-68 AN 3AQUIN LOCAL HEALTH DISTRICT 8/711 3H <br />