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FOR OFFICE USE:' - --APPLICATION fOR SANITATION PERMIT <br /> Permit No. <br /> -------------- -----------T------ lcomplete in Triplicate) <br /> � <br /> ' _:_ ;rf Date Issued a-- -- .:3 <br /> ---------------------=---------------------¢`;1; <br /> This Permit Expires 1 Year From Date Issue <br /> Application : ermit to construct an <br /> is hereby made to the n Joaquin <br /> orn jlian complianceal with Goune work herein <br /> alth ptytordinan a rict for a No. 549 and existing Rules tand hRegulafi ons, <br /> described. This application is ma„ s P L <br /> �-- -___._-CENSUS TRACT -------- <br /> JOB ADDRESS/LOCATION ----- - - - A.-- <br /> f <br /> Owner's Ndme '--- <br /> --------------------------------- -------- Phone <br /> I9`f ' =:5 <br /> /`3 R t n /I------- . City --- S--- ---------------------------- <br /> Address ----- ------ - � --- - --}� -------------- --- Phone ----- -------•---•---•------- <br /> � ------------------------------------------ License # --- <br /> Gontractor's 11 Name�.._._� <br /> Insfiallation will se ver Residenc-e:.❑Apartment House'❑ Commercial ❑Trailer Court 'E] <br /> t <br /> Motel F-1 Other _�R-_ Q ��� <br /> g i '=' y �}Cf� A_ --------- <br /> its.. <br /> Size <br /> Number of living un ---------- Number of bedrooms "`Garbage Grinder --- Private <br /> Water Supply ----------------------- <br /> = <br /> --- -------•------------ <br /> �...,,�-.--......�., _- :-- - - -----Silt clay ❑ Peat Sa1i�y <br /> : Publ;ic System and name - _s _ _ <br /> Character of soil to depth of 3 feet: Sar11 il-111 i ❑ ❑ Loam ❑ Clay Loam <br /> Hard an Y <br /> Sand <br /> 'Adobe'❑ Fill Material -____ - Y �type <br /> If, es --------------- <br /> Plot Ian, sFlowirig size of lot, location `of system in relation to wells, buildings, etc. must be placed on reverse side.) <br /> ( P _ ' <br /> NEW INSTALLATION: {No septic tan <br /> k oI se page pitpermitted if public sewer is av6iillable within 200 feet,} <br /> TREATMENT { ] SEPTIC ANK`(�] - Size----------------- -------------------- -- ------ Liquid Depth ---------------------.----- <br />` -- -- No. Compartments ----------------------\ <br /> PACKAGE TR ,-.. , Type ----------- ------ Material--------------- <br /> s Capdc�t'y'- yp Pro Line ---------------------- <br /> I Distance!,to nearest: Well -- ---------------------------- Foundation -- ------------ P <br /> I Total Length :------------ ------------- <br /> LEACHING LINE 1 j ] Noi'of"L•ines- : --_=------ -- --- Length of each line----------------- -- - --- ----•------------ <br /> - <br /> Depth Filter Material _------------------ r <br /> l 'D'jBox -------------- <br /> ---------- Type ;Fi;lter Material -------------------- P w <br /> Property Line <br /> . � Distance to' nearest: elf ------------------------ <br /> Foundation -------------- -- P ty ) <br /> '. i ,, a # Number ....... ---------- --------- Rock Filled Yes ❑ No <br /> SEEPAGE PIT: [;), Depth iameter <br /> Rock Size --. <br /> ------------------------- <br /> ------ --------- <br /> Water Table Depth -- --------------------------------------------- - - <br /> Pro Line ____-_-- <br /> `�" -Distance to nearest: I --------------------------- <br /> ----• -Foundation ------- --------- P• ---••--------- <br /> t r` <br /> ,� --------------------------------------- Date ---------------------------------} <br /> REPAIR/ADDITION{Pre/. Sanitation Permit# -- <br /> I` F ,- > � <br /> Septic Tank'('Specify Requirements) --------------- �� �l DA/� - <br /> <. „ <br /> Disposal Field; (Specify Requirements) ----- t r� <br /> Y nd ---------- ---------- ------ -- !'f + P _ <br /> ' ...� 3�-.^i-- -r- <br /> jacquin <br /> IR= ---- --- ------------------ ------------------------ ------------------------------ <br /> � t (Draw existing and required addition on reverse side) <br /> ce <br /> l h San <br /> 1 hereby cer fy that I have prepared this application�oRegulations tof the San Joaquin Local Health Distriict hat the work will be done in nHometowner or licen- <br /> County-Ordrnances, State.Laws,:and Rules a <br /> sed age t' ignatu/certifis the following: erson in such manner <br /> certiF th f i�fhfma ce the rk for which Yh'is permit is,issued, I shall not employ any pas to be o subjrk a C lawhof CaliforniaOwner <br /> ________ ______________f-____SBi ned �- ti n ---- ------------ <br /> By --- -- <br /> !(If tither than owner} <br /> i FOR .DEPARTMENT USE ONLY <br /> a h <br /> DATE "`.-11-----Z----------- <br /> APPLICATION, ACCEPTED;BY .. f -----------DATE --------------- ---------------------•-- <br /> --------------------------------------------- - <br /> BUILDING PERMIT ISSUED. -------- = <br /> 1 --- <br /> ADDITIONAL COMMENTS' <br /> ------ --------------------------------------- ---- ------------------- <br /> L - - -- _ ----------. _ <br /> ---- --- ----------- --S `�-----------------------_.Date_ �., <br /> t 3t � r �\ <br /> -------- <br /> Fin <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> F_ H- 9 1-'b8 Rev. 5M. _ <br />