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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> ----------- Permit No, . 7 ..... y ' <br /> {Complete in Triplicate) <br />.........................I............I................. � ._. J <br /> Dale Issued ...... ............. <br />...............................................•----..... This Permit Expires t Year From Date Issued <br /> 4 <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and Install the work herein <br /> described. this ap Iicoti n Is made in compliance with County Ordinance No. 549 and existing Rules on4 Regulations: I <br /> -6`s7— <br /> faeu�zs �srx .8ox� emus ,,�c <br /> JOB ADDRESS/LOCATION .._...._.�rY??----,.Q/-�--../�7� CENSUS TRACT ............... <br /> t <br /> Owner's Name ._------- <br /> _ . .r ........ <br /> .rte..est/. ............................ ............Phone ......... <br /> �Address ....... . City ............................... <br /> , <br /> Contractor's Name ..... ------ ......./,VX - Ucense # - .5'`C.-7- ... Phone --- <br /> a <br /> Installation will serve: Residence❑Apartment House Commercial Trailer Court 0 <br /> Motel ❑Other ----------r-�-- -------•--------- <br /> Number of living units -. Number of bedrooms _J!"_.-..Garbage Grinder -07'.— Lot Size ................... ................ <br /> Water Supply: Public System and name -----------------------------------__.........-----------------------............................_...........Private <br /> Character of soil to a depth of 3 feet: Sand[3 Slit❑ Clay ❑ Peat❑ Sandy Loam❑ Clay Loam <br /> iHordpon ❑ Adobe"❑ Fill Material ............ If yes,type ............... ............ <br /> (Plot plan, showing size of lot, to otion of system in relation to wells, buildings, etc. must be placed on reverse side.) ; <br /> NEW INSTALLATION: (No septic.tank or seepage pix permitted If public sewer is available within 200 feet,) 2 -w-w- # <br /> } <br /> IC TANK Size .y....................... Liquid Depth ....... .....-.......--"41* [ <br /> PACKAGE TREATMENT [ <br /> Capacity/gip Type Compartments .....'i......... <br /> Distance.to nearest: Well .....lQ.JP./...................Foundation ��__.......... Prop. Line ... ........ <br /> 7 <br /> LEACHING LINE No. of Lines --------/............ Length of each line........ Total Length ........ <br /> 'D' Box ..tj/---- Type Filter Material Vii. Depth .Filter Material .........���......................... <br /> Distance to nearest: We '....... Foundation -.-.- - -----.•••• Property Line <br /> SEEPAGE PIT Depth .---0215--------- Diameter ..__ Number -­--------- .......... Rock Filled Yes No (I � <br /> Water Table Depth ....--------W. ------- ................Rock Size ........... %.-........ <br /> I <br /> rest: Well / C ..---- Foundation ----, 4'.a...--- Prop. Line ---`:..._.. .---•--L. <br /> Distance to neo <br /> ------- ------ Date ------------------------ 1 <br /> REPAIR/ADDITION(Prev. Sanitation Permit# --------------------------- - ...------ <br /> t <br /> SepticTank (Specify Requirements) ----------------- ------• --....................................... ............................................................................ , <br /> Disposal Field (Specify Requirements) -----------------•----------------------------------.--•........................------- <br /> ----------------------------------------- <br /> 1 . . •------------ -------•- ..............-- --- <br /> --..-__--•_••.................................................•_... .. ..... P <br /> 1 ........................................ ----. ------ <br /> -------------------•-•------------..-----------•--•-----.--- <br /> -------..- -- --I-n' --------- '--••_--- ------d- - - - <br />� (Draw existing and required addition on reverse side) <br /> I hereby certify that I 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,01stricf. Name owner er Ilcen- <br /> sed agents signature certifies the following: <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 /> as to beco ub)ect to Workman's Compensation laws of California." <br /> r <br /> Signed .. --------•- Owner <br /> 4 By ---- •------------------------ - --------------- litle .-.....-------;------------------------•---------- ------- --•------- <br /> (If other than owner) <br /> R DE RTMENT USE ONLY <br /> APPLICATION ACCEPTED B - ---- •_DATE./I y 7I .------..... <br /> BUILDING PERMIT ISSUED .. .......... ..............DATE .... ..-.... <br /> - ------- --- -------------- <br /> IADDITIONAL COMMENTS ----- -- ----• ............................................ ­------------- ......... ...... <br /> . . -• <br /> -- Dote .`.._ _,. . ,� <br /> Final Inspection by/. ._ .. . -..-.:.--•--•---------•--•----------------------- ------ --••---•R <br /> Mi 13 2� 1-b SAN JOAQUIN LOCAL HEALTH DISTRICT 8�7h 3M <br /> 4 � ` <br />