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FOR OFFICE USE: <br /> ........... .......... APPLICATION FOR SANITATION PERMIT <br /> .._.. <br /> i ......... ...... ....... . IComplete.in Triplicate} Permit No. ..................... <br /> . <br /> ` - .... _._.. This Permit Expires 1 Year krom Datp Issued Date Issued ._....�...-.-...._. <br /> I li , - `- • <br /> Application is hereby made to the San Joaquin local Health District for a permit to construct and Install the work herein <br /> I described. This application is made in c m 1'a ce w! County Ordinance..No. 549 and existing Rules and Regulations. <br /> JOB ADDRESS/LOCATION <br /> .... <br /> I' ... L, _-.4 _... ...... .. f ......0ENS RA <br /> ...Owner's NameW .� .... ..Phonef <br /> r Address <br /> k ✓ ..� �,3City .......... <br /> ' <br /> __... <br /> f <br /> Contractor's NameI2;/ '� l .i� S �l�dt' 1 . ..... .................................. <br /> .................. ............License # .. Phone , . . ? <br /> k Installation will serve: Residence©Apartment House{]-Commercialrailer Court ❑ <br /> Motel ❑Other r <br /> Number of living units_____________ Number of bedrooms _:.._.....__Garbo eGrinder :....._:.... <br /> I' 9 Lot Size <br /> Water Supply: Public System and name ... <br /> ..•............ �.... ....�-�-- <br /> Character of soil to a depth of 3 feet: ..................................Private <br /> Sand E] Silt Q Clay 0 Peat❑ Sandy Loam Clay loam ❑ <br /> Hardpan 0 Adobe ❑ Fill Material ........... yes,type............... ............ <br /> (Plot plan, showing size of lot, location of system in relation to wells,`buildings, etc.' must be placed on reverse slde. <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted'if publEc sewer is available within 200 fee#,} }.� <br /> PACKAGE TREATMENT ( ]'" . SEPTIC TANGS ' ¢' , i <br /> Size... . ,.:,X:S..-. '..f <br /> ......... Liquid Depth �.� <br /> CapaGlty -e� ;�. TYpe E: <br /> CTMater#al_er7 ,� Com <br /> partments .�... <br /> Distance. to nearest: Well <br /> t --- Prop.T - ­ - - <br /> ----.------- Length of each Iine _,ZVPF.__.. _ ._-- Total Length .... �.`_.�.. <br /> ....;.. <br /> ............ <br />! D'1 Box _� . Type Filter Material,.,...A&UL_-Depth Filter Material .......... <br /> h - ---:5-r - -Distance to nearest.,WeII__...1.. ----- - .Foundation- ' — <br /> L3_-----------.Property_Line ...._.�--•••-...._... <br /> SEEPAGE PIT HI Y <br /> Water <br /> Diameter i ": .a .."Rock Filled Yes ❑ No 0 <br /> ..........:..... Number ----------------------­ <br /> De ter Table Depth --------------••-•----... ... A. �. .. .._ <br /> i <br /> I Size, <br /> Distance to nearest: Well -----...-- .....s:. .--....Foundation ..................... Prop. ,Line ...................... <br /> REPAIR/ADDITION(Prev. Sanitation Permit# _.........._...__.. <br /> il ------------------------- Date; <br /> Septic Tank (Specify Requirements} ...:.....-------------------- <br /> 1i ---•-•----- <br /> Disposal Field (Specify Requirements) --...-----.•_• ----._....---_-... <br /> I� --------------------•---••--•----...._._.. <br /> ---------------------------------------------ii " <br /> --------------------- .....................•.................................................-----....--•--•-........... <br /> T --..------------------------------------------ ---•-----------• --------------------------------------------•----.•--•---•-----•-....---•-.........._.......--•••----•• . <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 <br /> County Ordinances, State Lci'Ws, and Rules and Regulations of the San Joaquin Local Health District. Horne owner or liven. r <br /> • ` sed agents signature certifies;pthe following: <br /> r "I terrify 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 subje t Workman's Compensation I s of California." <br /> Signed ---- -M �- <br /> - -. � q`�-=-----. Owner <br /> BY ---• . ,l <br /> (If other than olwner) �"'� Title --.- ................ <br /> ! FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED F?4z;��,7 <br /> --------- <br /> BUILDING PERMIT ISSUED --" -------------- ...... DATE -3--30-.?d' <br /> ADDITIONAL COMMENTS ..--11 - ----- ----- .............DATE ....- -....._._.__...- <br /> - --•-------------------- •-••--•----•--•-•-----.I.....-- ..._._._..._. <br /> Final Inspection by: ----- . _. - <br /> s .� ,es "_...._.. . . <br /> EI'I 13 2t� �.-68 Rev. • - ..-------•----------•--------------------------- -------Date ... . . ..`.- ....-•---•----••----....-- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT 8/7h 3M <br />