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FOR OFFICE USE: <br /> `PIPLICATION FOR SANITATION PERMIT <br /> Permit No. <br /> -------------------------------------------------- <br /> (Complete <br /> . in Triplicate) <br /> -------I ------------------•--- Date Issued -------- ----------- <br /> ThisPermitExpires I Year From Date issued <br /> ----------------- <br /> 4 <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 /> _S-7 <br /> JOB ADDRESS/LOf.&TION -------R-D---------------------------CENSUS TRACT <br /> Owner UZZA __6 <br /> -- <br /> Owner's Name ------ .-VOL ------------ ------- -------------- ----Phone ----------------------- ------------ <br /> Address -- ----<---- <br /> one _71..... ------- --- <br /> V License <br /> Contractor's Name --- ---- Ph <br /> Installation will serve. Residence Apartment House,E] Comercial []Trailer Court 'C] <br /> Motel 0 Other <br /> � <br /> ---------------- .---- -- <br /> Number of living units .......---- Number of bedrooms ;-----------Gcsrbcs.ge rinder ------------ Lot Size --- <br /> Water Supply: Public System and name ------------------------------------------------------- ------------------ <br /> Private <br /> Peat FLI Sandy Loam 2rClay Loam.Cl, <br /> " <br /> Character of soil to a depth of 3 feet: Sand'® Silt E] Clay El <br /> y ------ <br /> Hardpan M Adobeo Fill Material ie�s�,type -------- <br /> reverse side.) <br /> (Plot plan, showing size of lot, .location"of system, in relation to wells, buildings, etc. must be placed on <br /> I <br /> NEW INSTALLATION: (No',septic tank or seepage;pit permitted if public sewer is available within 200 feet,) <br /> Size-------------------- -------------- ------------ Liquid Depth -------------------- <br /> PACKAGE TREATMENT I SEPTIC TANKf I <br /> q4`acit ------- Material. <br /> -------- --- -------- Type ------------- --------------------- No. Compartments ---_--•.-----•- <br /> ---------- --------- Prop. Line --------­_-------- —t <br /> Distance to nearest: Welli --------------------------- --------Foundation <br /> of..each line--------------------•------- Total Length :---•------------•---------- C <br /> LEACHING LINE No. of Liries - ---------------------- Length <br /> V;�113ox -- --------- Type Filter Material ---------------__...De pth Filter Material --------------------------------------- <br /> ------ - .----•-•-•-------•---•.. <br /> Distance to nearest: Well J"------------ -------- Foundation ------ --- Property Line <br /> SEEPAGE PIT Rock Filled '-Yes ❑ No 0 <br /> Depth ------------ Diameter ----------------- Number ----------------------------- <br /> Water Table Depth ------------------- -----------------------Rock Size -------------------------------- <br /> Foundation --------------- ---- Prop. Line ------------------------ <br /> Distance to nearest: Well ---- ----------------------------------- <br /> Foun <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------J---- -- i Date ------------------------------------- <br /> -------------------_--_-- <br /> -/--------------•--IV--A:�:----------------- <br /> Septic Tank (Specify Requirements) -------- ------- <br /> -7--------- <br /> Disposal 1`2ieil (Specify Requirements) ` -------pl <br /> ------------------------- <br /> �57X -------------------­- ----------------- ----------- ------------------------ ------------------- ---------------- --------- <br /> -------------- --------------------i---­-------------------- <br /> - ------------- <br /> -------------------------------------------------I-------------- <br /> - ------ -------------- ---- ----------- ------------- isting iind,requiredaddition-on reverse side) <br /> (Draw ex <br /> I hereby certify that I 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 San Joaquin Local Health District. Home owner or licen- <br /> sed <br /> IIcen-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 employ any person in such manner <br /> as to become subjec to W r an's Compensation,laws of California.7%, <br /> Signed -------------_-------.Owner <br /> Title ------------------------ ------------ ---------- ------------ -------- <br /> ----------- <br /> BY ....... <br /> {1f other than owner) , <br /> FOR DEPARTMENT USE ONLY <br /> DATE ----- ----------- <br /> ION ACCEPTED BY ------T-t-R-D----------- ---------------------------------------------------------------- <br /> APPLICAT __!7 <br /> BUILDINGPERMIT ISSUED:-------------------- :------ ----------------------------------------------w--------------DATE ---------------------- <br /> ADDITIONAL COMMENTS'... <br /> ---------- --------- ----------------- ----------- - <br /> ---------- ----------- --------------------------- -- ------- --- ---- L------ ------ - ---------------------------------------------------- - - <br /> - - ---------------------- ---- ----- ---------------------- ------------------- <br /> ------------- -------------- -- ----I------11----------------------------------------------- _7 <br /> - -- ---- ------ - <br /> \ - --a- ru <br /> ------- ------------ - -- ---- Date ---- --- -- ------ <br /> - -- --------------- ----------------- ----------- f <br /> Final Inspectiof­+-��:' <br /> SAN JOAQUIN LOCAL..HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />