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FOR OFFICE USE. <br /> "APPI,ICATIO-14-FORT <br /> ............ <br /> SANITATION PERMIt <br /> ...-.:....._ , ....................... ...•• �. .-, _ . (Complete in-Triplicatel � �Q� <br /> ...._.....•. .. This PerraltEx iroes 1 Y Dat, Issued-..----••--•....... ..... p ear Froin Dghissued Application is hereby made to the San Joaquin Local Health District for a <br /> described, This application is made in compliance withe aunty Ord' ante No- 5,49 and existing Rulesandthe Regu moons:@m <br /> JOB ApDREssAocATlo ../_.?_��:-7.-�..•� <br /> 1� x ..... CENSUS TRACT _.. <br /> Owner's Name .._ _� - f ................ ............. <br /> Address .................... .._ ' _....-_. --......__._.. .........Phone <br /> . -•_ � •---... ......... <br /> .........j-1-- . City <br /> Contractor's Name ..- .. <br /> - •------ License <br /> ••-•-- Phone <br /> Installation will serve: •--••-----•---•--------------- <br /> Residence 0 Apartment House{] Commercial railer�� <br /> i Motel ❑Other.--- ..:_.::. <br /> Number of living units_______ _ Number of bedrooms _3 � <br /> . ...._.._Garbage Grinder ._. Lot Size <br /> Water Supply: , -- <br /> . pp y: Public System and name �1 / - ------------ ---- <br /> Character of soil to ale_ .__... v <br /> a depth of 3 feet: Sand Silt Clay �':f-•----• Pri ate, . <br /> . Imo) y [} Peat[) Sandy.loom Mff Clay Loam 0 <br /> ;Hardpan❑ Adobe 0 fill Material <br /> ............if yea;,typa-.:,::-:.:........... <br /> (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc, must be placed on reverse side.) <br /> NEWS INSTALLATION: (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TAMC ) g �' <br /> . .. �: ':.._.Q.......... ... Liquid Depth <br /> hod <br /> . Capacity --•-•-------•-•---- . : M --............. , _. <br /> - TY�..�-'�"---'�. afar€ai.�$�- -•--- No. Compartments _.�"" <br /> Distance to nearest: Well �4- �-t ----_____ <br /> ..........................Found tion .4�... �._,..:..._ Prop. L€ne _ : <br /> LEACHING LINE <br /> No. of Lines ---..................... Length of each line_...__•---•----...-----. Total Length .. Q <br /> D' Box .. Type Filter Material �' Depth .Filter 'Material / Y - <br /> Distance to nearest: Well .��.".. Foundation _-Jif..:................. Property <br /> Line <br /> .�... � [ ! ----------- <br /> -•----••--- -----• R _� <br /> ©' --- ...........................o --•••-•--•-...... <br /> REPAIR/ADDITION(Prev. Sanitation Permit�# Prop. Lina ...................... <br /> - --- Date <br /> Septic Tank S . <br /> p ( pacify RaquirementsL..........:..... ...._ � . <br /> - ................:.... <br /> Disposal Field (Specify Requirements) _..................___ <br /> t: ... Y ----------•---- ---------------------------- <br /> ----------- ---------------- -----•••-- <br /> -----•-----------------•------- ------- ...:.....:.._a ............ ............................:----•----•:............... . <br /> 40raw existing and required ddditlon on reverse side) <br /> ! 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 t_he <br /> sed agents signature certifies the following: San Joaquin [oral Health,District. Home owner or litett- <br /> , <br /> "I certify that in the perform '---- <br /> once of the work for which this permit is issued, 1 shall not employ any person in suth manner <br /> as to be a subject man% Co ensatron laws Tel <br /> California." ` <br /> Signed - ---------- ' . <br /> - ------ - --------------•------ -- ------- •-- <br /> Owner + <br /> BY Title ------------ - ._.:._._. <br /> (if other than owner[ - <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY, ' <br /> BUILDING PERMIT ISSUED _•.-,_..;.-------- <br /> ADDITIONAL COMMENTS . <br /> �.......... . ........ ...o4.c�c.e /. _._.. <br /> 1e.7p . <br /> -- <br /> Final Inspection b {,/.� ---------- <br /> ----------- <br /> 1-68 <br /> -------- <br /> p Y- - i <br /> E!I l� 2t� 1--6f3 I�ev Date - <br /> v ,�� .? <br /> - �,.... <br /> .r <br /> SAN JOAQUIN kC3CAl HEALTH DISTRICT 8/711 3M <br />