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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> Permit No. ���-••-•••-•- <br /> _.:........ .i..... .................. ;Complete in Triplictitel <br /> y.. <br /> . ................. <br /> ............. Date issued ..7- ..-7; . <br /> This Permit Expires t Year from Date Issue <br /> For a <br /> ermit to construct and <br /> he work <br /> _ Applicatio ThsS eereb madersomadepn ca plian oc il with county District <br /> dinance No. 549 and ex sti g Rulestand t Regulations' <br /> rein <br /> a described. application. <br /> JOB ADDRESS/LOCQT1ONi. .: 3 C .......�- .. ... ./ �.. ... ... .. e ..a.. .._..-................. <br /> + �• �, <br /> .....CENSUS TRACT <br /> ... P <br /> C (` f / - <br /> .5 - �...}.. .. <br /> Owner's Name .1.4.- . on <br /> Address ... C �..... ... / .. city <br /> License /.�. Phone .......-... <br /> ,, �• ...... #�-.. . .._.. <br /> Contractor's Name .... <br /> Trailer Court ❑ <br /> Residence Apartment House❑ Commercial ❑ <br /> Installation will serve: <br /> Motel ❑Other .... ............ .............. <br /> " r ..... . Lot Size ....................................... <br /> Number of living units:,........ Number of bedroom, ......garbage Grinder Private❑ <br /> . <br /> t Water Supply P 1�lic System and name ....:...................... <br /> . Peat Sandy Loam ❑ Clay Loam ❑ <br /> ° Character of soil'to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ d <br /> r Hardpan❑ Adobe ❑ F!1!Materia! ............ II yes,tYPe <br /> t be <br /> on <br /> N <br /> [Plot plan, showing size of lot, location.of system In relation <br /> ofwulblicbsewergs available within 200feet,) <br /> reverse side. <br /> NEW INSTALLATION: [No septic tank or seepage pit permitted. <br /> SEPTIC TANK[ J Size...................... Liqul r <br /> : . <br /> PACKAGE TREATMENT [ J _•---,• No. Compartments ................... <br /> .`�".. ,. are --�•-- <br /> ",. Capacity ............ . Type .................... <br /> ra . <br /> > dation r Line...................... <br /> :..,;. Foun <br /> = Distance to nearest: Well . •• <br /> Prop. <br /> k: .... <br /> Length f eac Tine. .................. <br /> Total Length ........................ <br /> LEACHING LINE ,[ J <br /> No. of Li . .....: ........... <br /> Depth Filter sten <br /> ... ....Det Iter M v1 <br /> ................................. <br /> p' Box .-.---...... Type Filter Maters <br /> Property Line -•••• <br /> Distance to nearest: Wel! ......... ......... .• <br /> Foundation <br /> ........ <br /> Rock Filled Yes 0 No >D <br /> r <br /> Depth Diamet .. ....... Number R <br /> SEEPAGE P... ' [ [ P o i e .............................. <br /> 0 <br /> Water Table Depth <br /> ....R ck Siz <br /> Prop. Line ...7...... <br /> ;.� .., Foundation ...................• . <br /> 3:,,•. � Distance to nearest:We ............ ............................ <br /> / Date .................. 1 <br /> Prev. Soni,.ation Permit# - --••....... .............. ....... <br /> ;;;',•'. ': REPAIR/ADDITiON l ....--..............�........_. <br /> ,.: ; ................................................................ <br /> Septic Tanks.(Specify Requiremenisl - •-.. ........... ................. ............ <br /> (Specify Re uireme -• ............... �.. <br /> , . ... <br /> Disposal Fit -ISP Y q ---- i � .�1!- �/.�-..�....��,�..c..................... <br /> --•... ............' - r- ......................... ................ <br /> •....... <br /> ................. .. <br /> ............................• ................. will e <br /> ��� .-....-Ste':..:...... ..... . - - <br /> -�� [Draw existing and required addition an reverse side) <br /> I hereby certify that I have prepared this application and that the work •II b dons in accordance with San Joaquin <br /> County Ordinances, Slate Laws, and Rules and Regulations of the San Joaquin Local Health District. Hems ownetr or hcen- <br /> certifies the following: not em Ivy any person in such manner <br /> sed agents signature permit is issued, 1 shallp <br /> ;. "1 certify that:in fhe ,.rfarmance of the work For which this <br /> • • � non's Compensation laws of California. <br /> as to become.su6lect ;-j Wor <br /> Owner <br /> Signed Title <br /> c��'c.... .L .................. <br /> ..� Fi ............... <br /> By -' {if other than owner <br /> TMENT USE ONLY <br /> FOR. _ ......... <br /> _� <br /> ~ DATE ....��.��7-7 <br /> APPLICATION ACCEPTED BY -. `..........................-.....-..............-....-- DATE ........................................-.. <br /> BUILDING PERMIT ISSUED ................ ................................................ ..................................... <br /> ......................... <br /> ADDITIONAL':COMMENTS ............ ......... ._............-. . <br /> .... <br /> Ins ection by: ............. i .rte.......................... fe ... <br /> Da �o <br /> Fina P <br /> SAN JOACUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br /> I <br /> 1 ' <br />