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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ' (Complete in Triplicate) <br /> Permit No. ...7. '. � .. <br /> ................................ �d��� <br /> ..........................iR.................... This Permit Expires 1 Year From Date Issued Date Issued �J.......... <br /> Applicaon' is'hefe-6 <br /> timade to the San Joaquin LoealrHealtl-'District fora permit�to construct and install the work herein <br /> described. This application is made in compliance w.it'h•Counfy Ord inance;No.'549'and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .. (C ..... �,� ...... . .. .. <br /> �.%� .iX �'. -,/� �.!.(�° ,��.�-. .CEN5l1S TRACT _ _. <br /> Owner's Name ......... .. ..._.Phone <br /> Address f jel <br /> f�L� f.�lv"C . . y- •-•-- ... --•--.•.. City ...................................:..... . <br /> Contractor's Name ..... G?/�s'- `.' '>�-� - ---- --- -••- ,,9P; Uo"_ .�..-. Phone j` :ng . <br /> license # .....:: <br /> Installation will serve: Residence Apartment House Commercial ❑Trailer Court 0 <br /> - Motel ❑Other ...............:... .. <br /> - .............. <br /> Number of living units:--- Number-of bedrooms.2......Garbage Grinder o&!� . Lot Size .............:.. <br /> Water Supply: Public System and name ...:.........:................ .........................-- --......__--------_--------_--.._....Private, <br /> Character of soil to a depth of 3,feet: Sand . Silt❑ Clay Cl Peat❑ Sandy Loam 0 Clay loam 0 <br /> C ° Hardpan I] . Adobe '❑ Fill Material ............ If yes,type......................... <br /> L <br /> (Plot fan, showing size of lot,.location of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> NEW INSTALLATION: {No septic tank or.seepage pit permitted if public sewer is available within 200 feet,} <br /> PACKAGE:TREATMENT [ ) SEPTIC TANK ize,_ .:��AW�'-'_ <br /> �.•-- -- •• .. ...................... Liquid Depth ��.... <br /> Capocityl,� ...-_. TypO_ _ . 41. Material[� 2?_,Oc.__.. No. Compartments .'�............... 6 <br /> 0 <br /> Distance Jo nearest: Well ..Foundation -le.............. Prop, line . ......... <br /> S ....... - r s o <br /> LEACHING LINE No. of Lines .. ............... Length of each line-&-.1 Total Length .01.1................ <br /> oelp ..................................De th Filter Material Ze. <br /> 'D' i3ox l��_ - Type Filter Material „l� N <br /> Distance to nearest: Well .,�1�r .......:::.... Foundation - s .............. Property Line .`7---e.............. a <br /> J <br /> SEEPAGE Piz [ ) Depth Diameter ......L... <br /> ....... Number --- --------- .._... Rock Filled Yes ❑ No ❑ r <br /> Water Table Depth .........Rock Size ................................ . <br /> Distance to nearest: Well ........................................Foundation Prop.�line .. <br /> REPAIR/ADDITION(Prev. Sanitation Permit# ..•.•................_-----.---_--........ Date ..................................I <br /> SepticTank (Specify Requirements) ..................................................................................--......................................-................ <br /> Disposal Field (Specify Requirements) ....................................................................................................:.................. .............. <br /> .......... ........ ------------------­- ...... ---.._...---------••------..__............----••••--------------•-----•-•--•-----• ---....... ................... <br /> ........... <br /> t r x�..... .- <br /> ` (Draw existing and required addition on reverse side) ` <br /> 1 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 District. Home owner or licen- <br /> sed agents signature certifies the#ollowirig j -j <br /> °'1 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 become subject to Workman's Compe4aiion laws of California." <br /> SignedOwner <br /> ..,.. <br /> BY . <br /> ....- <br /> ........ .... �....__...: ......._. . Title __ !�f'`'.... <br /> (Ifo , than'owTierl I " .............. <br /> FOR'.-DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ..... -. 1 .................... DATE _...- =� '2. ......... <br /> BUILDING PERMIT'ISSUED ' ' DATE <br /> ................:..........................................•------••-•--•-••---•-=-•---..:..... ............................i.--------.. <br /> ADDITIONAL COMMENTS ............................. <br /> a... : .............................................................. ......................... •...._._....._...... <br /> ........................... ......... _, ._. : _ .. ... .......... <br /> -._._ ... .. •--- . <br /> f - <br /> _---- _ �...... <br /> : :.f.. •-•--- •-•-•-•---...Date ... <br /> Final Inspection by �..... ... <br /> ............. <br /> ,. SAN,.JOAQUIN,'LOCAL' HEALTH DISTRICT _ <br /> E_ H. 13 24 1_•bB 12Av_ 5M - 7 I�� 1 V <br />