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OR OFFICE USE: <br /> - APPLICATION FOR S4NITATION PERMIT <br /> ° Perm\tNo` x���=���� <br /> (Complete[rTriplicate) <br /> -° This Permit Expires I Year From Date Issued Dote Issued <br /> ------------- <br /> Application hereby made to the Son Joaquin | HealthDig,|cY for o permit to construct and 1nmoU the work herein <br /> described. This application is mode in cunnpUa—ncewith County Ordinance N 549 and existing Rules and Regulations. <br /> � <br /> Owner's Name /1,-- ----------- ------ -------------------------------- -- -----,4Prhn n e ----------------------------------- <br /> Contractor's Name ----- - <br /> Installation will serve. Residence pcirtmentHouse�F <br /> !L _] Commercia] :C]Traller Court '0 <br /> MotelF-1 Other -------------------------------------------- <br /> Number of <br /> --'-------------- <br /> Numberof living units: / Number ~---~ ' -- - `/ �~ ' �dar . [] <br /> ''—''Water Supp/y. Public System and no' -^-nu .---Pr�ure <br /> Character of soil toudepth of3feet. Sand'E] Silt E] O E] Sandy Loa Clay,Loam E] <br /> Hardpan E] Ado6e � 8Aoterio| If yes, type -----=�.--.—.- <br /> 1%..,(Plot plan, 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 available within 200 feetJ <br /> Copocity ------------------- Type -------------------- A8ptedoi-----.,�—. No. Compartments <br /> Distance to nearest: Well ------------------.'�-----'Foon6odpm .--._--_pnop.'Une ----.'�_.— <br /> � ' »w� <br /> LEACHING LINE [ ] No. of Unoa ------------------------ Length of each line--------------------- ------- Total. Length ------------ ............... <br /> 'D' Box —�1—.. Type Filter Material --------------------Depth Filter Material -------_._-'—_'^-' <br /> Distance tonaorost., Well ------------------------ Foundation ------------------------ Property Line ------------ <br /> SEEPAGE <br /> —'_-SEEPAGE PIT [ ) / -------------------- Dion�e�r ' m�mbo�, Rock R1�d y�u No �� ' <br /> ___~_------ --_� . [_---_' �_ .—.------- �� ' <br /> VVo+o, Table Depth ------------------------------------------------Rock Size -------------------------------- <br /> Distance to nearest: Well ----------------------------------------Foundation <br /> .—_--------- <br /> D|stoncntnneurem. VVe / -----_-------'--'Foundot(on -------------------- Prop'`Uma .--_---'_' i <br /> (Prev. Sanitation PnmnK# --------------- Date ---------------------------------- <br /> Septic Tank (Specify <br /> —'_—_'-__--']SepticTunk (Spodfy Requirements) <br /> ��� �� ���� <br /> ���� ��^ ���� ��� �=� —_ , <br /> -- _ , <br /> —'--' .—.��----- — . -_.--------w' <br /> ------_--.---.--__--_---__—.--._.- <br /> --------_--__-------_---._----_---------_---�-----� --------------------------------- <br /> (Draw <br /> ----./� (0,ovoxbtimgrequired <br /> and nylu ,a6 odd���n cm nyvmre� sk�a <br /> U hereby certify that U have pnepare� this application and that the work will be done in accordance with San Joaquin <br /> County Ord/nan*n*, State Laws, and Rules and Regulations of the Sam Joaquin Lw*m|lHemUth District. Home owner on licen- <br /> sed agents signature certifies the fmUo'w1ng; <br /> "I certify that in the performance of the work for which this permit is issued, U shall not employ any person in such manner � <br /> as twbecome subject to Workman's Compensation laws of California." ' | <br /> 3i 6OA------- --------------------------------------------- <br /> (I other wner) FOR DEPARTMENT USE ONLY � <br /> ADDITIONAL C"',",.",." '°°� <br /> --------------------------------------------- <br /> _---_--------------------------- ------------------------------------ -------------------------------------- ---._----------- <br /> � <br /> -------------------------------- ---------------------- -------------------------------------------------------------------------------------------------------------------------------------- <br /> ---_—_—'--.. '_.-----___. <br /> Rno| |nspec |unby ------- ... — --------------------------------------- — U.p <br /> ' ^ <br /> �SANAQUIN LCn��L HEALTH D|STR|[T~ . <br /> , . . <br /> EH. 9 1'Y0 Rev. 5M, <br /> ' <br />