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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> ......... . . ,. '..'. . _. Permit No. .':7�... <br /> (Complete in Triplicate) <br /> •••................ j? <br /> This Permit Expires 1 Year From Date Issued Date Issued ..f`: �....... <br /> Application is hereby made to then Joaquin Local Health District for a per to construct and install the work herein <br /> described. This application is made 'n compliance wit County Ordinance No. 544 and existing le and Regula ions: <br /> r <br /> �Y P<s�/ti <br /> JOB ADDRESS/LO TION .... �...__r�?..r. ._(2. 11�1fi : �l..�j.... -I� ..••......_CE S TRACT ........................ <br /> � � <br /> Owner's Name ... . ..a.. -------L of.z�.C:. ..............................I....._._.._ ... Phone .................................... <br /> CC t` � .....-- . <br /> Address ........----•.... ._...._.. . .. <br /> ........... .... ....3M. - �-- ] City / <br /> . --••-• License # _�1.� .. Phone <br /> Contractor's Name .. L' <br /> Installation will serve: Residence partment House 0 Commercioi ❑Trailer Court <br /> Motel ❑Other.......... ................................. �/ <br /> Number of-living-units:.............;Number of,POSiltI <br /> ms -._....Garbage,Grinder .____.... LotSize <br /> 'Ir ........... <br /> Water Supply: Public System and name _____ _ . ........- G ------ "a,-•.---------------••---•-••---..Private ❑ <br /> Character of soil to a depth of 3 feet: SanCay Peat C] Sandy Loam J3 Clay Loam ❑ <br /> Ho0,paK,0-- Adobe iIi Material /Y..'-�If yes,type .. ........ ........... <br /> (Plot plan, .showing size..of lot, location of.,' stem in relation to wells,,buildings, etc. must be placed on reverse side.! <br /> NEW INSTALLATION-" JNo 1 l ✓ sewer is available within 200 feet,) Z , <br /> PACKAGE TREATMENT [ 1 SSEPT IC TAMC seepage pit permitted if public <br /> Liquid Depth ---/...,, �'2r...•••-r <br /> o. Compartments <br /> Capacity .. yp ��!- -._.. ... Material :_ <br /> T e <br /> Dis to nearest: Well .-.-'•�! --........Foundation .. .............•__-. Prop. Line ................. H <br /> LEACHING LINE [ No. of Lines .... ---.. Length of each.line.', .___. .. -.. Total Length _.����..... <br /> Fype.Filter•<Materia ::.----•• Depth Filter Material -.. ................. .............0 <br /> star to rest: Well . L!-�' ..... Foundation <br /> -.---. .4 ------- Property Linej..--•--.....--'C <br /> SEEPAGE PIT '[Depth _._ ./--_- Diameter - Number ._._7..........•..._... Rock Filled Yes [;J O Q p <br /> .� , --�Water'Tab1e`Deptl7' 1/.°! ---.......I.....-..Rack Size .,l X .��... <br /> ' Distance to nearest: Well ...___i ------ ...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# :.:. ...................... <br /> ----------------- Date .............--------••---------••) •� <br /> Septic Tank (Specify Requirements) ............:.. .......... ..•-------•------------------- -•------ .............................................................. <br /> ..._. <br /> ,.�,.._ ----------- -- <br /> Disposal -Field (Specify Requirements)- -----------------......=...........-........................------------------ -------------- ------ --•-•------- <br /> : ------------------------•- <br /> ------------------------- ..._...._ .,_......__.__...:__:..----••--------------._......... -----------............................................................................................ <br /> (Draw existing and required addition on reverse 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, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licen- <br /> sed agents signature certifies'-the following: <br /> "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> F as to become subject to Work man's,Compensation laws of California." <br /> Signed - wn , <br /> ......:.......... ........•._.......'....-----------•--- - - . . C> er�� <br /> (if n owner) <br /> FOR DEPARTMENT USE ONLY _ F <br /> APPLICATION ACCEPTED BY ...... __ .. . . <br /> . . ..-•-•--•........................:.........•-------•--..........---.....-------. DATE ----�. �- ............... � <br /> BUILDING PERMIT ISSUED _...... DATE ..........................................} <br /> ADDITIONAL COMMENTS ............... . <br /> ----..............- :............ <br /> ....................".............._----..-------•----•---••-•---•-.............-•--•- ........................................................-• ----•--• --•--- ::: <br /> ........................ . ..... ..-•--- <br /> FinalInspection by: ........ ...... •. -•-• • ..... ...............:..:.:................ ..•-•--• ----•............---............--..Date ...._.... ... <br /> SAN..'JOAQUiN ,LOCAL HEALTH DISTRICT <br /> � 7172 3 M. �•� <br />