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FOR OFFICE USE. <br /> APPLICATION FOR SANITATION PERM <br /> ...........................:......................... Permit No. Z A-�.... <br /> lComplete in Triplicate) <br /> .....:.. Date Issued <br /> This Permit Expires i Year From Date Issued <br /> Application is hereby made to the San Joaquin Local Health District for a 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/LOl!C��A,,TIO --_... / I a t } f / ................................................CENSUS TR!A T�. <br /> Owner's,Name ..[/�. ✓YII�?�t. _.. ?l. f .i..C?'... .. .,. ...... Ph one`7. •.�a�13........ <br /> Address .......................................................City ... . �7� i... ...f.apt .?..................... . <br /> Contractor's Name - .:.....:..,-._:...__J�Liaense ........................ Phone ............................. <br /> Installation will serve: Residence�partment HOuse 0 Commercial QTraller Court C] <br /> Motel Q Other-:-•...•-•-•................................. <br /> Number of living units:...•a�~_--- Number of bedrooms ...- .....Garbage Grinder to Size ........................................... <br /> Water Supply: Public System and name - -......I............................................._............................ ....................Private ❑ <br /> Character of soil to a depth of'3 feet: Sand r] Silt❑ Clay ❑ Peat❑ Sandy Loam (3 Clay loam <br /> . ,• ._. Hardpan ] Adobe 0 Fill Material.............if yes,type............... ...:........ <br /> (Plot plan, showing size of lot, locati n 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 feet,) <br /> PACKAGE TREATMENf-4 SEPTIC TANK f I Size................................................ Liquid. Depth .................... 6N <br /> 6N <br /> fl Capacity ------------ Type Material._....................... No. Compartments 19 <br /> Distance.to nearest: Well ... ....Foundation ...................... Prop. Line <br /> LEACHING LINE No. of Lines ___ Length of each line...... <br /> ..-- -- ----•----•-• ...................... Total Length ............................ <br /> 'D' Box ....... Type f=ilter Material ....................Depth Filter Material ............................................. � - <br /> Distance to nearest: Well ........................ Foundation ------.................. Property Line ........................ <br /> SEEPAGE PIT [ ) Depth .................... Diameter ................. Number ._._.7...................... Rock Filled Yes ❑ No Q j <br /> WaterTable Depth ------•.........................................Rock Size --------........................ <br /> Distance to nearest- Well ___....Foundation .................... Prop. Line ` <br /> REPAIR/ADDITION(Prey. Sanitation Permit 5#•` ..................•......................... Date ............................... } � � <br /> Septic Tank (Specify Requirements).-----------• -•---- ------------------ ................ <br /> ,... 16�C1 :: <br /> Disposal Field (Specify Requirements) __ .__ --.. <br /> :::--------------------------------------------------------------------------------------------................... ......:....:......::::::....... :...........................: ':F .............. <br /> (Draw existing and required addition on reverse side) <br /> I hereby certify that 1 have prepared this application and that the work will be done in accordance with Son Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the Son 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, 1 shall not employ any person In such manner <br /> as to becomes bled WMa <br /> �11 laws of California. <br /> Signed -----���� -------------------------- Owner <br /> By --------------- •--------------------- ----- ----- Title .. �lsx..... . ......._.. <br /> (If other than Owner} <br /> R DEPARTM&4Y USE ONLY <br /> 7 Ste. <br /> APPLICATION ACCEPTED BY . . . ---- - DATE -1 .....�.L.......:..:...: <br /> BUILDING PERMIT ISSUED - DATE ...._...................... <br /> ----------------- <br /> ADDITIONAL COMMENTS ............................................•-••-------............................._......:..... ........................:.................... <br /> ._._.•.. <br /> C <br /> ............................................................ <br /> --- - ------.-------_--------------- ----- •-----. <br /> ----------------•---•----.._..... ------•---•-- ------... ------- - - <br /> FinalInspection by: ------ --------- ----- -------------------------- ---- ---------- ----------------------- ----..-Date .--------------- <br /> EH 13 21a 1-b13 i�v• 5�t SAN IOAQUIN L L H£ALTH DISTRICT 8711 31K <br /> C63 <br />