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`FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT �f �� <br /> Permit No: ... .. ..-.. . <br /> ..........-._............................_...•----- <br /> (Complete in Triplicate) <br /> _... ......................................... .. Date Issued <br /> ---.- This,Permit Expires 1 Year From Date Issued -. <br /> .............-.._................-.. 1 <br /> Application is hereby made to the San Joaquin Local Health District for a perit to construct and install the work herein <br /> m <br /> JOB ADDRESS/LOCATION <br /> is made in cornpfiance with County Ordinance No. 549 and existing rRule�ondoRegulations: <br /> described. This application <br /> _.CENSUS TRAC .. ------................. <br /> t <br /> ION .....�' ..-V /� 1� .... % e :OW. --f <br /> ��^ / ................ tort <br /> Owner's Name ............. 4:9;_V__/..Jf.r4tF/. .. .fir..---- _..-.._..<. -­;el- - <br /> Address - _Prt't. <br /> - 230.7. ._. ... City ----------------------------•-------__-_ <br /> Contractor's Name .fir .-.0.Ca. <br /> .-.License# ....................... Phone -------•............. <br /> Installation will serve: i Residence p Apartment House[] Commercial)]Trailer Court <br /> # Motel []Other------- -- <br /> Number of living units:...../_.._ Number of bedrooms ....Z.,...Garbcge Grinder Lot Size ------------- ---------------- <br /> 1� <br /> �-., -----------------••-----._............._Private uo <br /> uo <br /> Water Sd)iplyk Public System and name ------------------------•-------•---._._ _...----__- <br /> t Clay Loam�} S <br /> t Character aF soil to�6,depth of 3 feet: Sand o Silt 17 Clay Peat O Sandy Loam ❑ ; <br /> y e-------------.-...._--- <br /> Hardpan Q Adobe Fill Material _------._.. If es,type <br /> i <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc..must be placed on reverse side.) N 4 <br /> 'Q <br /> NEW INSTALLATION: (No septic tank or seeps -pit per <br /> if public sewer is available within 200 feet,) ` <br /> SEPTIC TANK. Size..1Q-Y.. r? `1.......... ....Liquid Depth <br /> PACKAGE TREATMENT ( � t 1�• 5a"' <br /> Capacity ' - TYP �__ Niaterial.e2iiii�. No. Compartments ..:�-�...-_•- <br /> t9�`� R 4 <br /> l tante 4o nearest: `Well .-aZ. .--- - - <br /> -•-- -Foundation _ ............. Prop. Line <br /> . .....:_<-:--•• <br /> LEACHING LINE-' No. of Lines .. �........... .:.. Length of each line.... ' --- �J Total length .------ - ' <br /> t - ............... ._ <br /> .Depth Filter Material ....._-..�.r�...- <br /> ): le 'D' Box . I Type Filter Materia r J� <br /> Foundation 0-�f---- ProPeM Line, CA---•-------__-••• ' <br /> Distance to nearest: Well . Y.. ' <br /> / �y�. Number ..---_Z...........------ Rock Filled Yes � No ❑ <br /> SEEPAGE PIT I� DePth �-� -� - Diemeter .X------ ' <br /> "- t40 Rock Size ................__.....--- -• Jif <br /> , Water Table Depth .... .......................................... - <br /> 7yvty? Distanceto' nearest:,Well .-- ------....•................ <br /> Foundation ..CD�2�.....•. Prop. Line . ..--........-• ; <br /> ! •----- Date _....-_..--•-_----••---------- <br /> 1 <br /> REPAIR/ADDITION(Prev. Sanitation Permit ---••--•••••--•- - <br /> Septic Tank (Specify Requirements) .......................................................... - ..-.._-...._.... , <br /> Disposal Field (Specify Requir ental ••-•----'=:.:n.c::.::.:..:..........._.._:..__...__--•-'-.._.._.............._._._........._.._.............--. <br /> ........._-----. ............. `-..........._i.......:...................---..........__._^-•-•-........_.-_..-•---•--------_......_..._---._..-••--._....-.__._......._...._........---_. <br /> . . . - <br /> } '.{ (Draw existing and required addition on reverse side} <br /> ( E <br /> t thereby certify that 1 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 the San Joaquin Local Health District. Home owner or licen- <br /> ', sed agents signature certifies the following: Io an person <br /> in such manner <br /> "I certify that in the performance of the work for which this permit is issued, I shall net employ y P <br /> as to bet a ublect to Workn n's CompensaH�w of California." -A— <br /> ' Signed ./�' --------^-..�_. n <br /> • - -- <br /> _... Title ------ ------ ----- .............. <br /> (If other than owner) <br /> AO <br /> R DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... ... ....._'. .. _. ....................... <br /> DATE ---.Z ............... <br /> ._..__...DATE ---------------- z--•--.._....... <br /> ' BUILDING PERMIT ISSUED _......---_--_.___.._.-----'..................`--------.._.. .. . -.._.........--^ _...•----------._....-- <br /> ADDITIONAL COMMENTS ..----;;y:----------__....•_•--••-----------•^•••-.-._.__•-..-.-...-.•. . .,r..................--.._....------.. ...................-__.. <br /> ------'............................... . ....----- <br /> ---------••......................---`--------------..............._....-....-----....------ <br /> ...............__...._._...-...-._...--..._..:.:..r. .......... <br /> .. _... ....-_ <br /> --- --------------- <br /> ---- -------• ........Oats._... .-------Q <br /> Final inspection by:'--•----- --- ---------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E.H. 9 1=68 Rev. 5M <br />