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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> Permit No: .............. <br />--•---------------------------- :----...... This Permit Expires T Year From Date Issued <br /> 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 Regulations. <br /> I' <br /> Gu , <br /> JOB ADDRESS/LOCATI <br /> .. -/_.1 ._._. A... ... ... .... .. .... .....I�tY� <br /> ................CENSUS TRACT .: <br /> Owner'sNarree'``: .... -•......... ........ - t__' - .. ......... Phone �1a�_ .r.141 ,�......... <br /> Address ,_,- - :.. _.. �- <br /> ...... City ...... <br /> Contractors Name ...............J . .....k-... --- ------- ___.License # ._. �} .... Phone Z' ..f, .. <br /> Installation will serve: Residence 0 el <br /> es encel Apartment House f7f7l Commercial oTrailer Court Q <br /> Number of living unit =Number. of bedrooms " <br /> .�. <br /> �- Garbage`Grinder .._...._..__ I.ot"Size":.._ ..... <br /> a � - <br /> Water Supply: Public System and name ......-...--•.--•--••............................:..........---.........._....................................Private <br /> Character of soil too depth of 3`feet Sand 0 Silt❑ Clay 0 Peat.p Sandy Loam o Clay Loam o <br /> Hardpan El. ,_..Adobe Fill Materlol ............ If yes,type ! <br /> (Piot plan, showing sizeof'loron reverse s <br /> location of system in relation to wells, buildings, etc. must -be placed side.)' ' <br /> I <br /> NEW INSTALLATION t (N o septic tank or seepage piitt,-per fitted if public sewer is available within 204 feet;) <br /> PACKAGE TREA fMENT . [ SEPTIC TANK ] Size.......................::..:.:..... •------___.. Liquid Depth <br /> ., - . .. - <br /> apacity _�`1---.------ TYAe ..------ Material------------ ------ No.—Compartments— �► <br /> 10 <br /> Distance to nearest: Well ...Foundation ....................... Prop. Line ` ` <br /> w :. <br /> 'LEACHING LIN£ -I.l No. of _. .. »Len th-of-each.ii a ..........-f .. <br /> n Total Length <br /> - t <br /> 'b Box ....:. Type Filter Material __________________Depth Filter Mater'ial .................................... <br /> ;Distance to nearest: Well <br /> •----------------------- Foun' ation .........-•-•--•---.....: Property line ,...................... <br /> �• t �. a .' <br /> SEEPAGE PIT - � ° <br /> [,) Depth .......... ......... Diameter Number y Rock Filled Yes No <br /> Water T'*­b-, <br /> Depth <br /> ----- .... . = --— •--....::RdWSize —,— `'�•. .--- <br /> e <br /> Distance b nlearest: Well __....Foundation ..................... Prop Lina <br /> r <br /> REPAIR/ADDITION(?rev.11an`itation Permit+# .......I......,.... 12__.......... Date . - __...••--...... ) . . ...«....... ... <br /> Septic Tank (Speclfy Requirements) -------------_----•----.. . ------•••. ......-- . ---................................._ . ... _.......... <br /> ,� <br /> Disposal fi�ield (Specify Requirements) .......l f!�.------- -- ---•- � X-c.!'�.c�..... .. ........ .I <br /> __ ........................................... ................ <br /> •___•_••.................................... -'.,ti -' <br /> - ---......••-----•----•---,.--...............:.... " <br /> '----------- ..-........._..._...____'_'._........ ----------(Draw.,existinq�and required addition on reverse side) <br /> 1 hereby certify that I have prepared thisappllcatlan and that the work will be done in accordance w ith San Joaquin <br /> County Ordinances, State Laws, and Rules and Regu'Qhions of the San Joaquin Local Health District. Norrie owner or licen- <br /> sed agents signature certifies the following: <br /> ���tsued, <br /> "I certify that in the performance of the work for which Ihis I shall not ernploy'any pars n in such manner I <br /> as to become subject to Workman's Compensation laws of California," � •�,,,, l <br /> Signed---- ----------------- ------ - ------ -- -- ............................................ Owner <br /> BY --- - -`"-------- - ----------- ---- ------- -----------------. - .------..._.. . <br /> (If h r than owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY �- I <br /> .. ............. ..._-..- _ 7 ........... DATE ...r3.'c `� r7.:................... <br /> BUILDING PERMIT ISSUED ......... ----------------------- ------- - DATE _...._.... ....................... <br /> ..... .. _ .- ' <br /> AL COMMENTS - .... <br /> --- <br /> •-"•---'...........}�:.�:....._.._.__..__.... ...._.._..:...:............_.......... <br /> ..............................•.............................;..44._) ......._... .^s_ .)h., '....... •1..............................................� <br /> Vi ......................................... <br /> ........................................................_..... <br /> .............. <br /> ..._:......_....................._...._........................_..._......__-••---...................................... <br /> ...--------------------------------------....................-... ',-_------•..--......_._....-----.._............................ .....__._.:.---.....-_..... <br /> Fina! Inspection by: �jl{j j$''--•..................... <br /> .......-•-----•......................... _....Date .... .. .....................-_...._._... <br /> SAN JOAQUIN LOCAL HEALTH DI` RiCT <br /> c m_13 24 iL_,,&a a__ cjA <br />