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FOR OFFICE USE: �. <br /> APPLICATION FOR SANITATION PERMIT <br /> t �� -------- Permit No. ..7 ............... <br /> (Complete in Triplicate) <br /> --••. Thi s Permit Expires 1 Year From Date Ensued 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 incompliance with.County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .. �, _ _..4 - .1.l /..rad .f"'_.'......:.....".. . .........:...............CL:NSUS TRACT • ;.:.. ....._ <br /> Owner's Name F�'!.r i f' �................ <br /> ............ Phone.................................... <br /> a � <br /> Address -----------------------S-�.� ............................ .r� City . ............... <br /> . -•---•----•--._.___....... � .......................... , <br /> Contractor's Name = lr�� ----•--.License #• :.'r., l Phone > �' 1 ... <br /> Installation will serve: Residence Apartment House❑ Commercial ❑Trailer Court <br /> Motel ❑Other -•..............:.............. ------ `r <br /> Number of living units----- Number of bedrooms ...�,--__Garbage Grinder /..G.P_._ Lot Size / ,6.9 :..............•••••--- <br /> Water Supply: Public System and name . � 1'' ... f ` ` -•------------ -Pr vats ❑ <br /> i <br /> f3.. <br /> Character of soil to a depth of 3 feet: Sand❑ Silt[I Cloy C3 Peat Sandy Loam ❑ Cloy Loam ❑ <br /> Hardpan Adobe-0 Fill Material ...........!if.yes,type -­------------------------ <br /> (Plot plan;-sk-99ying�size•t-of lot,i.location of system in relation to wells,i.buildings, etc. must be placed on. reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted ifpubsewer is available within,200 feet) <br /> PACKAGE.TREATMENT i 7 SEPTIC TANK Size.. ._ Li uid De th . ,� <br /> '---------•-•••-••------- a p .......... . _._ <br /> Capaci � �'11----=•- TYpe� Materidl�i�.�e�__'...-__ No. Compartments <br /> _ <br /> ; Distance to nearest Well `•'� f <br /> F Ft Foundation +. Prop. line : .9 <br /> i I Tot Len th _ - ._.......••---. <br /> LEACHING LINE t Q„ ,;No. of Lines: _.._ ._ _ Length of each line/a ___-__I.;.. ---- al g ,� l <br /> 'D' 'Box ',qf/p-... Type ..�f� <br /> Filter Material . . Depth Filter Materialt.. :................................••---• <br /> undation Pro er Line -- <br /> DistanCCto a'rest:,,Well ��. Foundation p rtY <br /> SEEPAGE PIT Depth'__4r- ..... Diameter : ...---.: Number_.... ..........�� -. __Rock'Filled Yes f No <br /> Water Table Depth ...A-) -� ...... ._._Rock Size -..__.. ................... ` <br /> t�istance to nearest: Well ......:....... ...Foundation _.,� _.._l. Prop. Line _. .-_------•-- <br /> 6 . <br /> REPAIR/ADDITION(Prev. Sanitation Permit#....................:...........'`.•-- Date ...:!.............................. <br /> I <br /> r <br /> Septic Tank (Specify Requirements) t �....-----•_.-••- <br /> Disposal Field (Specify Requirements) ------------------•--• -----.......,- :.........----•-........................ ----••..........-•---•--••......---..... i <br /> :".................................................. ... .. ___... <br /> (Draw existing and required addition on reverse side) <br /> IL <br /> y 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`Regulotions of the San Joaquin Local Health District. Borne owner or [icon- <br /> sed agents signature certifies the following: <br /> "I certify that in the performance of the work for whish-this permit is Issued, I shall not employ any person in such manner. <br /> k Trkman':Com eniation laws of California." <br /> as to become subject to,Wa p <br /> Signed ....................... ... ...............:. ... :......._..----•--•-• Owner_ <br /> --- <br /> 4 <br /> (If of than owriery <br /> 3 �V FOR DEPARTMENT'USE ONLY <br /> APPLICATION ACCEPTED BY ........... .�.. ......... .............. ATE ...._.. .. ��• •-••--:...__ <br /> ADIDIDTiONAI COMMENTS .... •-- :`..... - • DATE ... ..... ...... <br /> .. <br /> � .,::: : .n .:: , :::"::. <br /> . .... <br /> -------------------------------- •-•--•----.......... .... <br /> ------------------------------- <br /> .................................. <br /> .............................. -- -- ----- --•-- -------- ... ..... ..................----..----......_..---••••...... _o--t <br /> . ---. <br /> Final Inspection by: <br /> .................................................... <br /> .---.Date .. .. .._....._... <br /> .17 <br /> SAN_JOAQUIN v LOCAL HEALTH DISTRICT <br />+ 7.3 24,, o_., city 7/723,,4 <br />