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7_16k OFFICE USE: <br /> APPLICATION FOR .SANITATION PERMiT <br /> ....... ............­­.­............... Permit Noz/- <br /> ........... <br /> (Complete In Triplicate), <br /> .........................I.......... �1 .1 .1 - .. . <br /> Date <br /> ..........__......I.,......................... This Permit Expires I Your From Date Issued <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 made In compliance with County Ordinance No. 549 and existing Rules and Regulationst <br /> JOB ADDRESS/LOCATION TRACT .......................... <br /> Owner's Name .../09"?M ------------......................................Phone ......... ......................... <br /> AddressT IC IGS +fit <br /> .... .. .............. city <br /> Contractor's Name ... <br /> ----....License # one <br /> Installation will serve: Resiclence�Apartment House 0 Commercial C)Trailer C6urt 0 <br /> Mote <br /> l C]Other .--------•---------------------------- <br /> Number of living units--l-... Number of bedr9pms ....--Garbage Grinder .----------- Lot Size ------------- <br /> I C <br /> Water Supply: Public System and name I....... . to 1-1 <br /> -------...........................................Private <br /> feet! gal <br /> Character of sol!to a depth of 3 L] Silt.0 Clay 0 Peat 0 Sandy,Loom 0 Cloy Loom 0 <br /> M6terlal"—.. .... if yes,typeHardpan ............... ............ <br /> (Plot plan, showing size of lot,I <br /> ocation ofsystem In relation to wells, buildings, etc. must be placed on reverse sId <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> ................... <br /> PACKAGE TREATMENT [ ] SEPTIC`TANK I Size...... ..................................I...... Liquid Depth <br /> capacity -----I----------1._ Type ---------__ 'Material.:-------------_------�No. Compartments ...................... <br /> Distano0 i I 1\ <br /> to nearest. Welij ----- ..............................Foundation .......... Prop. Line ...................... <br /> a IV I I <br /> LEACHING LINE j No. of Lines ...... ----I--- Length of'each line Total Length ...-......... <br /> .Sr06 V Box Filter FZ,,< ..r..Depth filter Material ..... ................. <br /> .,. , ----- Ty'pe'�' M.4terial <br /> 9 N 4 1 1 <br /> Distance to nearest- 'Well ............. Foundation .... Property •Llne ...X. ........ <br /> wA 'G1 <br /> SEEPAGE PIT -------------••..... I---------------- NumberLJ'�-,................ ........ Rock Filled Yes [I No Col <br /> I Depth <br /> pevl�-y <br /> Water Table Depth - -----_--•--- =-----•-•------•--- Rb&Size ------------------ <br /> Distance to nearest. Well ........... -----------_--------Foundation --------------- Prop. Line .................t.... <br /> REPAIR/ADDITION(Prey: Sanitation Permit# ...........:-: --------_-----------------_ Date ................. ................1 <br /> Septic Tank (Specify Requirements) .............. ............................. .....................I........ ................. <br /> ........... <br /> . ... <br /> Dis Field (Sp .... ...R� 'irements) ------ .............. <br /> ................ <br /> ....................................................... <br /> -------------------------------------------------------- -------•-----•-----...---•---------••-•--•---------• ------ ........ ------_-_---------I.................................. <br /> Oraw existing and required addition on reverse side) } <br /> I hereby certify that I have preparJ <br /> d this applicallb-n-din-d 'will-Ilii-d6n-i In accordance with Son Joaquin <br /> County Ordinances, State Lows, and Rules and Regulations of the Son Joaquin (ocal Health District. Home owner or licen- <br /> sed <br /> icewsed agents signature certifies th4 4*16wing: , I <br /> "I certify that in the performanc; of.the work for'which-this permit is Issued, I shall not employ any person In such manner <br /> 05 to becomect to r i(rpbrits Compen !on laws of California." <br /> Signed <br /> ------ .... ... Owner <br /> - - ----------- -- ................................... <br /> BY ------- ............. Jitle <br /> (If other th, - <br /> e-- ----I— ------ --- ------------ <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY AA� ----I------------ <br /> ------------ --------------DATE ....................................... <br /> BUILDING PERMIT ISSUED ------------- --------------------------------------------------------------- .......I DATE ............. <br /> ADDITIONAL COMMENTS --------------- ------------------------------------- <br /> ---------------------..............1-------- .................. ----------- <br /> :----------**-------------------------------------------------------------------------- *----------------------------- <br /> ....................... ......................._----­------------------- .......I......I------------------------------------------------------------------------------- <br /> ---------------------- <br /> - ------------ <br /> ................. ................. ------------------ <br /> Eli 13 211 1-68 Rev. <br /> ----------- --- <br /> Final Inspection by: .........&:;;_I�SAN­JOAQU-IN---LOCAL HEALTH DISTRICT ........Date 8/7h 3M <br />