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FOR OFFICE USE: ('_�PLICATION FOR SANITATION PI~RO� T <br /> t. Permit <br /> (Complete in Triplicate) <br /> ..................... ...................I...... J <br /> - Date Issued .- <br /> _ This Permit Expires 1 Year From Date Issued <br /> Application is hereby made-to,the 5 n Joaq in Locol.Health District for a permit to construct and install the work herein <br /> described. This application is macle"in compliance with County'Ordinance No, 549 and existing Rules and Regulations. <br /> ---......_._ <br /> JOB ADDRESS/LOCATION .....�� �••�-- CENSUS � ._.Q................... <br /> r , <br /> - �n�, . .. ...._. <br /> Owner's Name . .tSdG.. . .. . .........:...:........ .. e ....._... _ .97:.. <br /> Phan 1�., L <br /> Address -............. ........ . ---G-----tip -- ..... City ............. ............... . ................................ <br /> •---•-..... License.# . . _.... Phone <br /> Contractor's Name ................../.�.- .. . To[J.� �P._._....... <br /> Installation will serve: Residence ❑ Apartmerit House❑-•Co merciai GTrailer Court <br /> ! f <br /> Motel ❑Other ..:".----•-:-------•--•-�-=�=------------- <br /> s J`-" ,' <br /> Number of living units:............ Number of bedrooms ------Garbage Grinder ......___.. Lot Size .. . <br /> Water Supply: Public System and name ----- ---------------------•----..._---:- --------------._.......-•-•---•-- --..........---•............._Private ❑ <br /> Character of soil to a depth of 3 feet: Sand n . Silt❑ Clgy ❑ Peat[3 Sandy Loam C-], Clay Loam C)- �y y 4�.�f� . <br /> Hardpan ❑ Adobe Fill Material .....__._._. If yes!type ......... _--=-.•� -� <br /> (Plot plan, showing size of lot, location oUsystem� in relation to: wells, buildings, etc must be placed on reverse side.) <br /> NEW!INSTALL•ATION: (No septic.tank or seepage pitpermitted if public sewer is available within 200 feet,) <br /> PACKAGE 1IkEATMENT { ) ,SEPTIC TANK-'[',) Size....... ��'' Depth .....................:.... <br /> ...._ •• • •-••-- .... - liquid <br /> Capacity ._n? '` ``�'' . Type .................... Material _... __ . No. Compartments ...'................ <br /> Distance to nearest: Well ............................ <br /> ........Foundatio»,...................... Prop Line........................cc <br /> LEACHING LINE [ ] No: of Lines __- --------- Length of each line________________........_.. Total Length ............................r <br /> It -•.......................................... <br /> 414 R4 <br /> .D' Box ._:___.__._. TYpe''Filter Material ..._._..___}..__.�Depth Filter Material <br /> rw} r <br /> Distance to nearest: Well ....................:.:..Foundation ........................ Property Line ........................ <br /> SEEPAGE PIT [ ] Depth .: .:_..-:w Diameter........--:. „Number--............ ................ Filled Yes ❑ No i❑ <br /> --Water-Table.Dept"hlq�.......... - - ............Rock Size................................... <br /> G <br /> Distance to nearest: Well .......Foundation _ Prop. Line <br /> REPAIR/ADDITION IPrev. Sanitation Permit# ....---••••-•...................•---...._.-- Date .................................. <br /> SepticTank (Specify Requirements) ................ •------•--• ----•--•--•-••--•--•.............................•------•--- .............................................. .. <br /> Disposal Field (Specify Requirements) ......... .__ --------------------------- -------- <br /> ... <br /> F <br /> -------------------------------------.._ ---------..---- � ----tU�... � ��._.......----•-•--....-•---•---._.......---•--•-----.-.•-.._..-----•-•--••-•- <br /> ---------------------------------------------------------"............... --------------------u..........................----•------.........----•---••-- .:...---....... .................. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that I have prepared this !applicat:on,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 LocnlrHealth District. Home owner or licen- <br /> sed agents signature certifies the following: ,] <br /> "I certify that in the performance of;,{the,work for;whlch this permit is issued, I shall not employ any person in such mann <br /> as to become subject to Workman's Comp sation:lbwsof�Cilifornia." <br /> Signed .....•------- ...........----- --------- --- •-•----�- -- •------- ----------._�_. Owner <br /> By ................ --- ..................._.__.......... Title _......_- ..1.rin...................... <br /> (I o er n owner) <br /> FO DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY ...,/ _ ._ :,._._.. ...... - ...... DATE .. ..� �1.. ................ <br /> BUILDINGPERMIT ISSUED ............................... ...............................................................-..........QATI? ..._.......:...... <br /> ADDITIONALCOMMENTS ......:................. -•---------- - ---------------------........................._................. ..................... <br /> ............................................... ...... -•------------- <br /> . •---•--------_. ---••- <br /> ' ........... .........Dote _._.. --------- <br /> Final Inspection by: .. �� ..� ._��... ._... <br /> SAW JOAQUIN ,LOCAL HEALTH DISTRICT _ <br />