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' FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT �f <br /> -------------------------------------------- ---- Permit No. --_/-- <br /> (Complete in Triplicate) <br /> --------------- This Permit Expires 1 Year From Date Issued <br /> Date Issued -._---.-_-__--•_.! <br /> Application is hereby made to the San Joaquin Local Health District for a per to construct and install the work Zrein <br /> described. This application is made in cornpiia a with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB AbDRESS/LOCATI N .- _244_041144� -- ------- -`--- --- ---1W__0_-16_?_CENSUS TRACT -------- <br /> ff <br /> Owner's Name -------- 6 ---- -� �------------------------------------------- -------------------------Phone -�(a�-`--��_/�__ <br /> ------- <br /> r � 4 <br /> Address ------------------ � -- ----------- -RC..... .fit-------------- City - ------ <br /> t Contractor's Name -----------r---- - '`f' SOS'---------------------------License # =UD- f {------ Phone <br /> Installation will serve: Residence IMApartment House[] Commercial ❑Trailer Court ',❑ <br /> Motel ❑ Other ------------------- ------ <br /> Dumber of living units..--/------ Number of bedrooms --�....Garbage Grinder ------------ Lot Size ------ - " --_-._-------- <br /> 1 f <br /> Water Supply: Public System and name ---------------------------------•-------------------=-------------------------------------------------------- Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silto Clay ❑ Peat❑ Sandy Loam ❑�� Clay Loam ❑ <br /> } <br /> Hardpan g Adobe Fill Material ------------ If yes, type ---- ' '-------------- <br /> k � - <br /> r (Plot plan, showing size of lot, location 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 /> a / <br /> PACKAGE TREATMENT SEPTIC TAN KK, p Size------- ------------------ Liquid Depth :-.. ------.. ...__---... <br /> Ca acit � .- �f-_ Type .JEriT_-__- Materia llJf _______ No."'Compartments` __ ......�:.. <br /> Distance to nearest: Well ------ -------------------------­Foundation Prop.,Line <br /> LEACHING LINE ( No. of Lines --------�---------- Length of each line____ -------------- Total Length ----------------- <br /> 7L ' <br /> D' Box .- -__✓- Type Filter Material ___-.__Depth Filter Material -----1 ----- -----------------------' <br /> ,{ <br /> Distance to nearest: Well _- 0-- -------z Founda#ion ---------- Property Lir'se --5- -----------------It <br /> SEE <br /> ----.- <br /> SEEPAGE PITADepth --- S ------- Diameter -T`------:_ Number ------_ __.-_-.-'-_ __ Rock Filled `'.Yes' ' ,No ❑ <br /> Water Table Depth { --------------Rock Size - X `.• <br /> t Distance to nearest: Well ____e-I----------------------------- --- Prop. Lines_--9�7�...... f ,� <br /> REPAIR/ADD[TION(Prev. Sanitation Permit# _-------__------------------ -------------- Date ____--__---___.-----_---_'-_-_-I <br /> I � <br /> Septic Tank (Specify Requirements) --'`-�=------------------------------------------------------------------------------------------ <br /> r <br /> Disposal Field (Specify Requirements)�----------,- '- � --------=--------------------------------------------- <br /> /; ------------=-------------------------------------------------------------------------------------------------- <br /> ----------- -------------------------------------- ---------------------------------------- - <br /> _ ----- --------- <br /> (Draw existing,and required addition on reverse side) <br /> I hereby certify that I have prepared this applicafiion and that the work will be done in accordance with-San Joaquin <br /> t <br /> County Ordinances, State Laws, and,Rules and,Re'gulations of the San Joaquin Local Health District time 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 er'rnploy any person in such manner <br /> —,as to become subject to 1Norkman's.Compeniation laws of Calif ornid,'� <br /> ! Signed `~:= t -------- ------• Owner <br /> By <br /> 04, f ------------------ Title -------------- �Y------- <br /> --------------- - <br /> -- --------------- --- -- - <br /> { her-than owner)` s <br /> �a r <br /> ` FOR DEPAitTMENT USE ONLY_ p' <br /> APPLICATION ACCEPTED BY ----- ,---- --� �. DATE?-"L.�-� ��-------------------------------- <br /> BUILDING PERMIT ISSUED ---`---- \ DATE "fi` �= - <br /> ADDITIONAL COMMENTS ........ ______ Y" ` <br /> --------------------------------------------------------------------------------------------------------------------------------- <br /> R -------------------------- -- ---- <br /> ------------------------------- ----- ----- - -------------------------------------------- --------------------------------------- ------- ------------------- -----•--•- <br /> i <br /> t - - - --------------------------------------------------°------------------------------------. ` ` <br /> Final Inspection by; <br /> - - - ------ --- --------------------------------------------------------------------------------Date J y7 <br /> l <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'6$ Rev. 5M <br />