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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT Permit No. ._��-�-= <br /> (Complete in Triplicates <br /> Dateissued :7� <br /> Phis perrnit Expires i Year From Date Issued <br /> and <br /> e work herein <br /> Application is hereby made to the Son joaqvin <br /> I ancecwiHh Couealth nytrict Ordinarna No. 549 and rmit to nexis i g RulestandhRegulations- <br /> described. This application is made in compliance <br /> ............. <br /> CENSUS TRACT -- <br /> JOB ADDRESS/LOCAT ON ....1 - .......•... .. __.-- <br /> P ..... <br /> an .Gl; <br /> a-- <br /> Owner's Name - - --- -- � -- - •--- --- ........... <br /> ---City ,. ......_-. <br /> Address . .._. ------- - - ------ - r ------- <br /> License # . 3 .... Phone ....�7��. <br /> S s� <br /> Contractor's Name ---•--- -------- �-•----- •- ---•. ........... .......................... <br /> .... ....... <br /> Installation will serve: Residence p Apartment House`Q Commercial❑Trailer Court Q <br /> Motel ❑Other ..................... <br /> ' Lot Size... 4 � ��--••-•-...... <br /> / �- Garbo a Grinder ............ <br /> Number of living units:--__f Number of bedrooms -.- -•--•- 9 <br /> ito <br /> Water Supply.- Public System and name ._....-----•-•-------------•-----•.--.---.....__>...... <br /> ._.---•••• .. <br /> pp Y' -Sandy Loam Clay loam ❑ <br />'l Character of soil to a depth of 3 feet: Sand ❑ Silt E] Clay ❑ Peat❑ <br /> ❑ <br /> Hardpan Adobe 0 Fill Material ............ If yes,type ............... ............ <br /> p <br /> n showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse s!d®']� <br /> #Plot pia g within 200 feet,l <br /> NEW INSTALLATION; (No septic tank or seepage pit permitted i# public sewer is <br /> available w 1 <br /> Size...------•-- ... Liquid Depth --•........................ <br /> PACKAGE TREATMENT [ <br /> SEPTIC TANK{ ] •--•----•-•-------•..:.......... <br />!- Capacity;�-----------•------- TYPe •----•--:---••----- <br /> Material....---••------• <br /> No. Compartments ...... 9,i <br /> ._Foundation ._. Prop. Line ...................... <br /> Distance;to nearest: Well ._.---............................ <br /> 1 <br /> ] Lines -----•.-------•--------- Length-of each line--------- <br /> ..:.... Total Length ......................••..-- . <br /> LEACHING LINE ( No. of L Depth .Filter Material ............................................ <br /> D' Box ..__.-__..__ Type Filter Material ................. .. p <br /> Foundation Property Line ........................ <br /> Distance to nearest. .................... . . No Q <br /> Diameter Number ....................:........ Rock Filled Yes ❑ <br /> SEEPAGE� PIT [ 1 Depth ' <br /> ------ <br /> Water T'ble Depth -----•-•------••--•-----•-•-•-- -•----- <br /> Rock Size ------------••--------------- <br /> Pro Line .....:..--••----- <br /> Distance,to nearest: Well ....................... ................Foundation ._...- - ----- p <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ......_ -------- _ <br /> •--------- Date <br /> ! i ...... / -;- <br /> .t <br /> ' Septic Tank (Specify Requirements) -------- ......... <br /> - �.�_.....__ ._.._..__.. .......... <br /> Disposal Field (Specify Requirements) _S­ <br /> -- ------- -------- <br /> ...................... ...........................-._............. <br /> ..; <br /> 1----------------- ------ -•-•-------------------• -----------------------------...................................................:. ........... <br /> ... <br /> (Draw existing and required addition on reverse si e <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance wttf+ San Joaquin <br /> County Ordinances, State Laws;rand Rules and Regulations of the San Joaquin Local Health.District. Homs owner or lican- <br /> sed agents signature certifies the following: erson in such manner <br /> i "1 .certify that in the performance of the work far which this permit is issued, ! shall not employ any p <br /> asto be e s [e t to Wo r n's Co ensation laws of California." <br /> G l6P ------- Owner <br /> Signed .... r _ ---------- <br /> -- -------- <br /> ........_•. 7itie --- -•- ----- <br /> {If other than o nerl <br /> Fj6R DEPARTMENT USE ONLY _ <br /> DATE ..... ^Z.3� ...---. <br /> APPLICATION ACCEPTED <br /> BUILDING PERMIT ISSUED -- •-- ---- ......... .............. ............ ..... ._ --•-•...__.-._....I----------- -- ------- ------ <br /> ADRITIONAL COMMENT ..___ -" <br /> ---•----•-• --------•------ ------------- <br /> ........ .: ........... :.._ :._..._-.-------I—............ <br /> k / 1 ��- <br /> .�- <br /> - Date -----...�:. --- <br /> . . <br /> Final Inspection by: ........... .... . - . . . . <br /> Eli 13 2!t 1-68 1teV. SAN JOAQUIN LOCAL. HEALTH DISTRICT $I7� 3� <br /> Y <br />