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FOR'OFFICE USE:t. ` <br /> APPLICATION FOR SANITATION PERMIT, <br /> - ------- 7- <br /> Permit No. _ x--3-_7-•- <br /> �� > X� (Complete in Triplicatel <br /> This Permit Expires ] Year From Date Issued <br /> Date Issued <br /> --------------- ----------------------------------------- <br /> Application is hereby made to the San Joaquin Local Health District for a per 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 /> _ ..__�_ y_• f .-.- - CENSiJS TRACT = - <br /> --.._--_T <br /> JOB ADDRESS/LOCATION ------------------------ ' -------- <br /> Owner's -N- ame _ �n <br /> ( <br /> ---------------Phone -- - -- <br /> ---- <br /> '- ----------=___= 'Address C _ <br /> ---- - - ------------------- <br /> -------------License --, '- - Q�`- Phone <br /> Contractor's Name -------- -- ------ ---- ---- -------------- ---------------- # _ <br /> Installation will serve. Residence [ Apartment House❑ Commercial ❑Trailer Court [] <br /> ' . <br /> . Motel ❑ Other -------------------------------------------- <br /> _N <br /> ---------------- -------------------•---_N r of living. units-------- Number of bedrooms ----� .Garbage Grinder ------------ Lot Size ..-4-0--_ .414,pa-.--------- <br /> i Private ❑ <br /> Wate¢ Supply: Publlic System, and name ----- F <br /> Character of soil to_//a depth of 3 feet: { Sand'❑ Silt❑ Clay ❑ eat❑ Sandy Loam ❑ Clay Loam ❑ I <br /> Hardpan ❑ Adobe.W Fill Material ------------ If yes, type ---------------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, .etc. must be placed on reverse side.) <br /> NEW INSTALLATION: (No septic tank or seepage pit permitted}if public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [,] SEPTIC TANK'[ ] <br /> Size--��-------------------------------!---------- Liquid Depth --------------- ---------- <br /> it1 <br /> No. Compartments <br /> ------------------- Type -------------------- Material------------------ - <br /> .4 1tDistarice-to- nearest: Wel! ----------------------------- ------Foundation --------------- ProP• Line <br /> -------•------------- <br /> LEACHING LINE ��.No.-of Lines -- ------------- Length of each line---( -QT r= Total Length : --------- <br /> { 'D' Box ---I------ Type Filter Material ------- -----------Depth <br /> --- ----Depth Filter(Material ------ I.e_. ----_----------------- `� <br /> Distance to nearest: Well. -�__: Foundation. -.-=______-O- ------ Property Line .-�---------------- <br /> SIPr4�f-PIT i Depth _-.-.�� --_- Diameter� �� --)Number 1___ -.-____----- Rock Filled Yes No i❑ <br /> ., __ - <br /> t ------ <br /> Size - <br /> = Water Table,Depth -----------------�40----------- r------- <br /> _�-� Prop. LineDistance..to nearest: - <br /> REPAIR/ADDITION(Prev, Sanitation Permit-# ------------------------- ------------------ Date--_-_-----__-.--------------------1 <br /> Septic Tank (Specify Requirements) ------------------------------------ y --------- --------------- <br /> Disposal Fi'el.d (Specify Requirements) ---------------------, ------ -- --- J----- ------------ ------------------- <br /> -------- --------------------------------------- - ---- <br /> ---------------------- <br /> ------------------ ------------- <br /> --------------- ------`---------------------------- ------------------------------------------------------------------------------------------ <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, Siate Laws, and Rules and Regulations of the San Joaquin Local--Health- District. Home owner or licen- <br /> sed agents signature certifies`the Foltlowing: ?� `" "" `'/` r <br /> "I certify that in the performance of the work for which this permit is issued, I shall note employ any person in such manner <br /> as to become subject to Workman's Compensation laws of California." <br /> Signe Owner ; <br /> -- - --------------- <br /> ------ ------ ---------- ---------------------------- ------ <br /> BY ------------ ---- <br /> Title --------- <br /> (If other than owner) <br /> FCWDEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY DATE -.�T�= 7- ?'r^ -------- <br /> - -- ----- ----------- - - -------------------- <br /> BUILDING,PERMIT ISSUED-------------------- ------------------------------ -------DATE.------------------------------------------ <br /> ADDITIONALCOMMENTS --------------------------- --- ------------------------------------------ ----------- ----------- <br /> ----- <br /> --------------------------------------------------------------------------------------------- <br /> ----------------- --------------------------------------1--- ----- -------- <br /> Final Inspection by: ._'� ..- -.Date -. - - ��� . <br /> - - <br /> SAN AQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M G <br />