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APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) <br /> ........... ............... <br /> k ............. ............w.•........ ............... This Permit Expires�I Your from Date Issued Date Issued .. ...... <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein <br /> ► described. <br /> escribed This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulcmanss <br /> . .. ................. <br /> JOB. ADDRESS/LOCATIOt(4-,.- 7. ..�✓ ..........................................CENSUS TRACT .......................... <br /> Owner's Name ............ ........ ....... . Phone ........ <br /> ----------- <br /> Address..........................62 <br /> .......... .... .. ....�XIF46_2� city --i-L-W <br /> XNA... <br /> Contractor's Name ....... ..........--jAcense . Phone# <br /> Installation will serve, ResidencailgApartmAt"H useJ3 Cornmerrial 01'raller Court <br /> Motel []Other ........................................ <br /> Number of living unitsi.... -----Number of l. ....... <br /> bedroc�m_s,..-._3,..,�7:GPrbc;ge Grinder ............ Lot Size .. ........................... <br /> Water Supply: Public System and name ...... \�)-In ... y- <br /> ................................................. (3 <br /> Character,tok. <br /> -soil-to ddiapthof 3 feet. Sand 0 SIlt,0 Clay O. Peat 0 Sandy loam C) 0, M 0" <br /> 4 <br /> Hardpan[3 Adobe"'"fill Material ... ....It�y44#iyfm <br /> IPIot plan, showing iize of lot., location of system In relatlon "ta'Wells, buildings, etc. must be placed an reverse side.) <br /> NEW INSTALLATIONs':� (No septid ta;k or' seepage pit perly <br /> mitted if public sewer is available within 200 feet] <br /> PACKAGE TREATMENt" f I SEPTIC TANK f ILiquid Depth .......................... <br /> 1 Size....... ..................................... <br /> Copaclty,�................... Type ......... Materibi_tom.................<�Nd. Comportmenti. ...................... <br /> DI stan <br /> ce-fib nearest. Well ....................................Fou'ficlation ...................... Prop. Line ............... <br /> LEACHING LINE No. of Unies ........:t._':. ..:. <br /> t_ Length of each line....: <br /> ........................ Total Length ............................ <br /> i. .'D* Box ... Type Filter Material ....................D�� filter Material ........I.................................. <br /> .Depth <br /> Distance to nearests Well ......................... Foundation ........................ Property Line .................. <br /> .7, Depth ............... Diameter ................ Numberk..._......_..._...._...._.. Rock Filled Yeti NO <br /> Water Table Depth .......... ........a......................Rock-sin ................................ <br /> Distance to:nearestt Well ......... ...............................Foundation .................... Prop. Line ...................... <br /> REPAIR/ADDITION(Prey. Sanitation-Permit# ............................................ Date,.................................. <br /> Septic Tank jSpeclfV Requirements) .............. . ..... ........ . .. . ... ............. . .................. . ............................ <br /> p-e` <br /> dfy Requirements) <br /> Disposal Field (S ........... <br /> ...............................................................6.........4w........... ..... ................. <br /> ................................. ..................................................... ........... ....................................... .......................................................... <br /> (Draw existing and required addition an reverse tide) <br /> I hereby certify that.I have prepared this application and that the work will he done In accordance with Son Joaquin <br /> County Ordinances, State Laws, a9d'Ituf9s and;Regulations of the Son Joaquin Local Health District. Homo owner or Peen- <br /> sed agents signaturo,.!co�rtikqs,.thpfollowings <br /> "I certify that In the p6riormante of the work for which I is permit Is Issued, I shall not employ any person in such manner <br /> as to become subject to Workman's tampensatioW4aws if California." <br /> Signed .... ...........I...................... Owner <br /> By ....... ....4.. ,Tr ...................... Title <br /> ............. ........I....... ........... ......... <br /> �If of t an owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY .... ............. ................ I/ DATE �J�.............. <br /> Z .. ........................ <br /> BUILDING PERMIT ISSUED .......... DATE .L'.......................­................ <br /> I. ADDITIONAL COMMENTS .......... ... <br /> ................. .......... <br /> ...........­­.t............................................ ......................... <br /> ---------------------------------------------­......I �1.1 <br /> ............................... .................... .......I.......................................................................... <br /> ............... ............ I I <br /> ............................ ..... .......................................................... <br /> ................ ........... <br /> final-Inspection-----*...... ----------­............ ---------- --------- ........... <br /> by: .... ................ ..........11......­­.............11.......... ............ Date ........ .................................. <br /> EH 13 2h 1-68 Rev. _qj <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br />