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FOR OFFICE USE- <br /> F`FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT <br /> Perm:) No. <br /> .................... ..... ............... ICoatplete In Triplicate) }• a�•�� <br /> Date Issued...... ..... ... / <br /> This Permit Expires I Year From Dan Issued <br /> . <br /> trict for a <br /> mit toconsifuctond install the <br /> ' <br /> This ocapli otioon�n1�.eis made made to the <br /> compliance,withuin Counrylordiint ordinance 549 andexistingRules and Regulations:work herein described. <br /> JOB DESS/LCiCATION _... .-. .. . �� ..........1.•rt.IS. ...../ . :........ ..........CENSUS 1RACT. ........... .-.. ... <br /> Le -s F(t�er t ... ........ __._ ... ..............:. ..... .....,.... .. Phone ..-.c...:.......... ..... .. ...... <br /> ' Owner's Name v `' <br /> i� Are? fiuiR. � RP►e ..... .. zip...�.M............. ......... <br /> Address...._ �f <br /> 292y ... Mill fv+a.... ... .....city.......... <br /> 3 l E'. .Phone.....'.:.............._......... <br /> . .................License #.ef.•.�. . .. .. . <br /> . .. . ........ ........... ............. . <br /> Contractor's Name.......��9��!f Q• - <br /> ; <br /> Installation will servo: Residence 1p Apartment House Q Commercial❑ Troiler Court Q � <br /> Motel Q Other. ................. ................. <br /> iNumber of living units: ..............Nvmber of bedrooms....._Gorbage Grinder............Lot Size......_l I�f -- •• Q- <br /> ........:.........:j..;;..............:. �...... Private [� <br /> * Water Supply: Public System and name-.. ............................... # Peat Q Sandy loom 0'-,C <br /> oy loom Q <br /> Character of soil to a depth of 3 feet: Sand® Silt Q Ciay❑ 'I ..If yes,type Hardpan p Adobe Q Fill Material.. ..+- -• <br /> (Plot plan, showing size of Tot, Inca+ioof system in relation to wells, buildings,etc,must be placed on reverse side.) <br /> W <br /> NEW INSTALLATION: (No septic tpr 'or seepage pit permitted if public'sewer isavailable within 200 feet,) i S <br /> �b1 ' LiquidDepth..:_y � - -` <br /> PACKAGE TREATMENT I ) SEPTIC TANK I l <br /> Size........ ............ '-kms ..........._...: <br /> ......T fist � •Maleriol.....Ceoxv.. :..:NO- Compartments—.....'.C2 . ....... ... g <br /> Copaciry. _ .. .. ype...A........ .. ... .' Us �?�...............t <br /> J /(9bf Fouls lotion......�.. ._-. .. 'Prop. Line ....... . _. <br /> Distance to nearest: Well ; ..... r 2 frit <br /> LEACHING LINE I 1 No. of lines '.. ,3 .... .:.. , ..Length of each line_.. .. ......•• Total Length ._ <br /> ,.. ..h...r. <br /> D' Box Type Filter Material, II�•"°Da;pth Filter Motorial. <br /> r r <br /> S <br /> Distance to nedresh Well......1 P0.0t <br /> •• • Fo ndation...... <br /> to <br /> '.......r...... ,Property Lme... .. . <br /> Rock Fill..Yes Q <br /> NO <br /> Q <br /> SEEPAGE PIT I 1 Depth.,..... ..Diameter............... .-Numher................................ <br /> Water Table Depth........................... .....!.,..,.......... ...,...Rock Size.. .... <br /> .. <br /> 11 ) Pro Line..._.................. ... <br /> Distance to nearest:Well............. ..........�............;.....Foundation. <br /> . ......... ..... ., . . p. .. <br /> III REPAIR/ADDITION IPrev. Sanitation Permit#...............:.:.....'.- <br /> 00te..........................................._3 <br /> '! +e�w '_:C....._ ..^...:................--.......:................_....... .,_--'-......................-...- <br /> Septic Tank (Specify Requirements)---`.... •••••......•••••••-•'•.'r•' "" <br /> t , :......_......_......- ...._..............•-_.................--- ..............--.. <br /> Disposal Field (Specify Requirements)--.... ......... .........t...........�......... t <br /> ....... <br /> i..._.....1..........' - <br /> .•• - .....••................. ......... .... ....... ' <br /> I...........i........................................._........-.. ._....._. <br /> (Draw existing and required addition on reverse side <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home owner or licensed agents <br /> ' signature certifies the following: .; i arson in such manner os <br /> "I certify that in the performance of ileo work for which this permit is issued, 1 shalt not employ any p <br /> ' to become subject to Workman s C pensation fawn' of California." <br /> Slgned�s/ . <br /> J _. <br /> . .....:.. . <br /> By......... �f!!... .... ... (if.......... .. <br /> (If other an owner) — <br /> I A PARTM T USE ONLY <br /> DATE .. .. .. <br /> 9 <br /> ' APPLICATION ACCEPTED BY :.... .. / DATE ,. . . <br /> DIVISION OF LAND NUMBER_..............•..... <br /> ADDITIONAL COMMENTS. <br /> ................ .................. .. . <br /> t <br /> .............. <br /> .................. .................... ........ <br /> ............ .. <br /> Oen_ .......... . <br /> O <br /> Final Inspection V -• fssots» ssv.tris: <br /> Ly;: ................. <br /> En a t. SAN JOAQUIN LOCAL HEALTH DISTRICT <br />