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FOR OFFICE USE: FOR OFFICE USE.- <br /> APPLICATION FOR SANITATION PERMIT <br /> - <br /> -------- -------------------------------------- <br /> ----- Permit N ............ <br /> ---------------- ... ................ (Complete in Triplicate) Date Issued.?0�1--t!­;v <br /> .............. .. ............. This Permit Expires I Year From Onto Issued <br /> Application is hereby made to the-Son Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compi 'ionce with County Ordinance No, 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION .. .. .. .......CENSUS TRACT....................... . . . . ......:....................x <br /> Phone........ ...................... <br /> Owner's Name-:- ......... <br /> Address......................... ..........mp­-, ................... <br /> Contractor's Name..'.. .......... License Phone.......... <br /> lns'tallation.will serve- Residence[-]*. Apartment House <br /> E] Commercial <br /> M8telE-0the .......................... -----------........ <br /> Number of.living units;................Number.of bedrooms__-_.__:---Garbage Grindev.t Size________________________________________ <br /> --------------- <br /> Water Supply: Public System-ond:name...........:......I---.-:_---:. ------------- --------------------------------................... ___---___.;_.Private <br /> Character of soil to a depth of 3 feet• Sand El IS* ilt 0 Clay❑ Peat F] Sandy Loam❑ Cloy Loom <br /> 'Hardpan Adobe Fill Materio I-.........If yes,type................................. <br /> - <br /> (Plot pla'n, showing size of lot, location of system in relation to`; eilsl, buildings tett. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic t6-n--k­.o- r seepage pit l5erm'ItteWIfpublic sewer is available within 200 feet,) <br /> ipp <br /> PACKAGE TREATMENT I 'SEPTIC tAN [1] J <br /> . Size__________________ _____ -__ ..................Liquid Depth---------------------­----- <br /> ........ Compartments--•---- <br /> ........ <br /> Capacity.--• :....... ..... <br /> Distance to nearest. W ell. ......... Foundation......... x._._.._..Prop. Line....................... <br /> LEACHING LINE No. of Lines.._.,:._E_-___.............7L-e--n- e a ch Total .Length.::..,..-----.......................... <br /> 'D' Box..............Type Filter Material!______i............Depth Filter Material.--_-_............................. --------------- <br /> . —1 ­. T <br /> tDistance to nearest: Welly--:`..--t... .....Fo,ndbltio'n----------------- ...........Property Line__.____._____.._____-______._.__ <br /> SEEPAGE PIT [ ] Deptii. Diameter..:_._. `k ,24umber­� <br /> .....................;...... Rock Filled Yes❑ No <br /> Wow Tab.l�ep�tk­-,,,. ................. -------------­----- ----------------- <br /> nearest- Well,-,--.........................Lr"­.Fol6ndation- k..Prop. Line..'-..................:..., <br /> REPAIR/ADDITION {Prey_ Sanitation Permit#.... ------- ------­- ................ n..----D' t <br /> a----- -- -­Yv.. ........... ........ <br /> Septic Tank (Specify Requirements).......................... .......*......................�A­ ............................................ <br /> Disposal, Field (Specify.R;equirements)------4 ........ . .... .......................... <br /> 14d 4-, <br /> .......................T.... <br /> ...........................­­............................ <br /> -•-----------------------•= .................... ............................. ---------------........................ -----.•••.._:...-•-----•-.....---- ----------- - ..... -------- ......... <br /> (Draw existing and required <br /> utied addition on reverse side) <br /> I hereby certify that I have prepared-this-application and that.the 'work- Will be-,d6ne-in-accordance with San Joaquin County <br /> Ordinances, State-Lows,—and—Rules..;,.and—Re'gul"ons.of_the.,­$an Joaguin Loial Health District. Home owner or licefted agents <br /> signature certifies the following:-- <br /> "I certify that in the perfohm'a-'n't,e--of;the vwork;for whic"is ps�rmii'is'isiued, I shall not employ any person in such manmir4s; <br /> to become-subject to.Workman's C!Mpt!jsatioll�laws of.California." <br /> t <br /> Signed..:......------------------------ -------- - nor 4 <br /> By.............................. ........................ <br /> : . <br /> . ........ .... e---- <br /> (if-other than owner) <br /> 'FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED.-BY--- ..........-5 A-% .... .. .......DATE'.' 97.............. <br /> .............................. <br /> DIVISION OF LAND NUMBER..........­... . <br /> . ......... ..... ......... ..............DATE--............... ------- <br /> 40DITIONXECOMMENTS........Lm... ­:.....:......•••--•-•:--•. ....................... -­-------­ ............................................------------­------ <br /> ........................... <br /> ..............:------ ............ .................................................... --------------- --------------------- ---------.......................... <br /> .............. ........... -------- ....... ---------- <br /> ........-....I.........::..-.-.-.-.-.-.�.:.-.-.-.-.-.--.-.-.--.-.-.-.-.... -----.-. <br /> Final Inspeciion-by:...........C.t --- - ........... ----De-- ---- <br /> --------- ............................................ <br /> EH 13 24 SA J AQUIN LOCAL HEALTH DISTRICT F&S 2T677 PEV..ini'3m <br />