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{ 'FOR OFFICE USE; <br /> •' APPLICATION FOR SANITATION PERMIT <br /> /� �' <br /> .................: ti'!!`/........_.._...._ YfPermit No,•.-:::::i:::........ <br /> lComplete In Triplicate) <br /> ...................................-.................... <br /> - <br /> . This Permit Expires ] Year from Date Issued 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 /> R qJ, <br /> JOS ADDRESS/LOCATION ! /. ...............CENSUS TRACT .......................... <br /> Owner's Name ^�...... !!!__ . .--fir.. .?.....a...............................:......Phone ...�:��..: <br /> Address 4. ,'7 .. <br /> Contractor's Nome Zfl- .....___...................................................License ........................ Phone .__.......................... <br /> Installation will serve: Residence, Aparrttment House'E],�Commercial OTraller Court 0 . <br /> •• y.. � <br /> Motel Q Other......................................... <br /> -------•_•_ ............�.....:.... <br /> Number of living units:..... _... Number of bedrooms ......_Garbage Grinder .___..__..._ <br /> Water Supply: Public System and name ..................................................................................................... ......Private ❑ <br /> Character of soil to a depth of 3 feet: Sand M- Slit 0 Clay ❑ Peat❑ Sandy Loam 0 Clay Loam 0 <br /> « Hardpan ❑ Adobe❑ Fill Material ............ If yes,type............... ............ y,] <br /> (Plot pian, 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 avail b within 200 feet,[ <br /> PACKAGE TREATMENT [ SEPTIC TANIC f ] �/v�Si . __`. � �-ST/""� Liquid Depth .......................... <br /> YA1y ...____ <br /> Capacity --------------•- •- T - <br /> Material._..--_. .... No. Compartments ...................... <br /> Smi <br /> arest:.�Vllie�l_«,.- .------------------------ ---Foundat_ion .............-•---.. Prop. Line .... <br /> LEA INGVNE ~4No.ViLines -.--____ <br /> �[- - C�-..-...._. Length of each fine------�..7 �Total Length . e'*'_.7:S ........ <br /> D' Box —�t Tic / <br /> ' Type Filter Material ...1 ......ode Filter Material <br /> i -4 c4to n6arest:`"Wel1 ... Foundation . .-•Q ............. Property line 1-a.....:....... - <br /> SEEPA�Pl Depth ......... Diameter . _ Rock Filled Yes Q No ❑ <br /> ---------------- Number � C`•.r�-�---�--------- <br /> 1 Winter Table-Depth ' ...Rock Size ------------- <br /> I I <br /> s ----------•---- - <br /> Distance to nearest. Well I . _.__Foundation . Prop. Line ...................... <br /> REPAIR/ADDITION(Prev.1Sanitatien-Perm it ....?__•_____________••- ........... Date `- �---------•...... <br /> ...____.) <br /> tti � , <br /> Septic Tank (Specify Requirements) ---Y._____---_-• w_•---•------ .... <br /> isPosat Field-(Specify. Requirements) C!` f1r� r v.. �....._ ...t ,Gl�c.. ..... .. <br /> G� <br /> i - -{Draw fitting and required'addition on everse side) <br /> I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin <br /> County Ordinances;;Stoteila- ws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or Rem- <br /> sed agents signature`certif'res the following: �.�' , <br /> C"I certify that in the performance of the work.for'whlch this permit is.issued, 1 shall not employ any person in such manner <br /> as to beton, sublet to Workman'*-Compeni6ition ��%. <br /> orni�a,...�....Signed - --------- _.._-- . ' Ower----•---------------- -• <br /> By - ...... ------- <br /> --------- <br /> -- ""Title ..------ <br /> Y (If other than owner) / <br /> - -� - --- ------- <br /> _ FOR ARTMENT LI ONLY, _ <br /> APPLICATION ACCEPTED BY .-_/. _. .. ...- --- ----­---------------------- -----•--- -------------�`..- _..------ DATE ..---... -----l��---� -----= <br /> BUILDINGPERMIT ISSUED -------------------------------------- ----------..--. ------••----- ------------------------------------ <br /> . <br /> ADDITIONAL COMMENTS . -•---"�•--- ----- --------------------- ----- ------------- -----------............... <br /> ..._.. <br /> � . r <br /> ----- ---- - - --•---------...._... ._..._ ----- ------ ...... <br /> / <br /> Final Inspection by: ----------........................................Date ..-. f r. <br /> ' � 13 2!� 1-613 �v. � / -- •---._....-- <br /> SAN JOAQUIN CAL HEALTH DISTRICT 8/7W 3M =" <br />