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FOR OFFICE USE. <br /> ----------- --- <br /> -- ---------------------------pq----------- APPLICATION FOR SANITATION PERMIT <br /> -------------- (Complete in Triplicate) Permit No. <br /> --------------- <br /> App This Permit Expire's I Year From Date Issued Date Issued ----------- <br /> Application is hereby made to th; Son Joaquin Loc6l Health District for , 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 /> JOB ADDRESS/LOCATION rep <br /> -- ------ <br /> Owners --------------------- <br /> Name --- -- - CENSUS TRACT ----/ <br /> Address ------ ---- ---------- --- ---------------------------- <br /> ---------------------------------Phone <br /> Contractor' ------ ---/01--- --0,f0yV city ........ <br /> Contractor's WAI -- --------------------------------------------------- <br /> Installation will serve.Q -----------------------------------------------Lice' 'nse a-5-Q—Phone <br /> Residence E]Apartme' <br /> nt House-E] Commercial DTra I)er-Court. <br /> Motel QTOther rK4e <br /> Number of living units:-__--------- N I umber of bedrooms--opf ------ <br /> ....Garbage GrinderC,3--------- Lot Size <br /> Water Supply: Public System and name ------ <br /> ------------ <br /> CL <br /> Character of soil to a depth of 3 fel --- -----------:------------------------------------PrivatewE <br /> et. SandE] Silt. ❑ <br /> 0 Clay F] Peat D Sandy-Loam0 'Cloy,Loam.[] <br /> Hardpan El Adobe P---Filf Material If yes., type "_-"---t-" <br /> (Plot plan, showing k --N------------- <br /> size of lot, location of system in relation to wells, buildings 1) <br /> etc. must be Placed on reverse side.) <br /> NEW INSTALLATION: (No septic:tank or seepage pit permitted if public sewer is available within'200 feet,} <br /> PACKAGE TREATMENT SEPTIC TANK <br /> Size----S-X--fX..V............ ... <br /> Capacity jiR---- �-- TypePe1g;: f"t - %.L ----- Liquid Depth -- ------------- <br /> I Material Compartments ---'2-- <br /> Distance P ---------- <br /> to nearest. Well <br /> -----------------------Foundation -8-W <br /> ---------------- Prop. L <br /> of Line Line <br /> Total Length _ 4761 <br /> LEACHING LINE No. s ---- ------------ Length o;,,eoVne-.-3/�,�-1 1 1 . /", <br /> 'D' Box Type Filt . .........• ------ <br /> er Material /Z .;�4D- <br /> I--------- e <br /> I -pth Filter Materi <br /> Distance tolnearest. Well --- all ------- <br /> --------- Foinclation <br /> SEEPAGE PIT De'p1h ----------- Pr6perty Line <br /> -------------- Diameter <br /> -------- Number ----------I---------------- Rock Fi ed Yes <br /> Water Table Depth ------------- No (E] <br /> --- --------Rock Size,- <br /> Distance to nearest. Well <br /> I -----------------------------Foundation <br /> REPAIR/ADDITION(Prev. Sanitation Prop. Line ---------- <br /> Z tation Permit# ........ <br /> Septic Tank (Specify Require\ q Date ---------------------------------- <br /> ments) -- ------ <br /> Disposal <br /> Field--(-S--p--e--c-i-f--y- Requirements} --------------------q--------- ----------------------q----------------------------- <br /> , --------------------------- <br /> I <br /> - ------------------------- -------------------------------- ---------------------------------------------------------------- ------ ----------------.----.--.----------- ---------------•---- -- <br /> - - ------- D1 <br /> f ------ -------------------- ---------- <br /> (Draw existing and required addition--o-n--reverse side} <br /> ------------------------------------q----------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and lRules and Regulations of the San Joaquin Local Health District. <br /> sed agents signature certifies the following: Home Owner or liven- <br /> sed <br /> certify that in the performance'of, <br /> the work for which this permit is issued, <br /> as to become subject to Workman's Compensation I&ws of Californicl.91- I 'hall"not employ any person in,such manner <br /> Signed ---- i <br /> ----------7--------------------- <br /> ------------ <br /> ------------------- r <br /> wtie <br /> By ------------- ----------- --- 0 <br /> (If other than -- ------------- Title ---- --- <br /> w r) ------------------------------------- <br /> RTMENT USE ONLY <br /> APPLICATION ACCEPTED By_ I <br /> BUILDING PERMIT ISSUED -- -V ---------------------�L----------------------------- DATE <br /> CO -------------- - --- -- ----- ---- -- - ---------------- ----------------------------------DATE <br /> ADDITION� -- -------- <br /> ---------------- ------- ------Ir 4---- -- ---------- - - ----- - - ------------------------------------------------------ --------------------------------- <br /> ------ -------------------------------------- -- ---- ---- -- ------------ - --------------------------------------------- <br /> ----------------------------------------------- <br /> ----I------------ --------------------- ---- ---- ----------------------------- --------------------------------------------- ----------------------------------------------------- <br /> Final Inspection by: - --- - ------ - ------------------------------------------- ----------------------------------------------------------------------------------------------------------- --------------------------Date -------- -A-------- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 <br /> 1-'68 Rev i5M. <br /> V <br />