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FOR OFFICE USE: � -- � � 1 <br />APPLICATION FOR SANITATION PERMIT <br />'. _ (Complete M Triplicate) Permit No.....�^•z3 <br />_. r _........---............_......... t This Pormit Expires i Year horn Dsats Issues" _ _ .. - Date issued . 3-3 X, <br />.Appllc tion is hereby made to the San Joaquin Local Health District for a permlt to cd tstruct and Install the work herein ; <br />destdbld. This application is made in with County Ordinance No. 549 and existing Rules and Regulations: <br />)OS AD ON _.....�i <br />owner:'NameI? /c"�!N _?................... <br />.. ................ }...._ CENSUS TRAC.................................:.:~._'.'�: <br />z.. <br />�Pitome <br />Address ..................... .:;?.. i`a ..:..... ' �` City ` S ........... .:......... <br />Contractor'! Nome............ .�. _ ........Ucense # <br />installation will serve: Residence Apartment Nm6' '3 Commercial oTraller Cow <br />Motel Q Other ...........E r! <br />Number of Iiving units....... - .Plumber of,bedrooms . . t _Gto arbage Gri//nder .......: Lot_ Size �.. <br />Water Supply: Public System artd name ':�:.... .._.._......r...._.---- 41I <br />�" <br />%................--...._.....Private <br />Character of soli to a depth of 3 feet: Send-[]-Silha ZT0_ p ._po4.fl -._Sandy Loam [] Clay Loam <br />Hardpan p `` 'Adobe 0 Pill Material cr... tf yn, t�►pi'..'............ I........... I <br />(Plot plan, showing -size of lot, location of system in relation 'to wells, buildings, aft must be placed on reverse side.) � r, <br />NEW INSTALLATIONt (No septic tank or seepage pit permitted if public sewer is available within 200 feet,) <br />PACKAGE TREATMENT ) ] SEPTIC TANK Site. ..................... Liquid Depth ..................... <br />Capacity .............:...... Type ............. : material..... ........... No. Compartments ............. ......... <br />,� Distance. to nearest: Well .Fovndation Prop. UrsaLEACHi�LINE (] tido. of Lutes ................ ..: Length of.each line- .. _V ........._... Tota) ...... <br />'D' Box ............ Type Filter Material ......... .......... CepA'Filter MaWial..._.....:_................. d` <br />Distanceto nearest: Well ........... _........... Foundations................. ... Property Line ....................... 0 <br />SEEPAGE PiT [) Depth .................... Diameter.......... . .plumber �� Rock Filled <br />.... Yes ❑ No C� <br />Water Table Depth .............: .........................,.......Rock Size ....... p" <br />Distance to nearest: Well . . s ........ j.....Foundation ...... ....._ Prop. L1M ................... <br />REPAWADDITION (Prev. Sanitation Permit qlt ...... .........•........ ...i............. Date ................. �„ ...) y <br />—Septic Tank (Specify Requirements).......................:.i -. .».� ....•. r <br />... .......................................�.............. <br />S`Disposal Field (Specify Requirements) ._....... ._�........................... 1 . <br />............ ....... I.......... ...................................... ........................................................+.................. ..... ................. <br />(Draw existingnd arequired addition on Oeverso ) side................................................ I <br />:1 <br />I hereby certify that i have prepared this application and that the work will be dons In aaerdance with San Je"VIR <br />County Ordinances, State Laws, and Rules and Regulations of the-Son Joaquin Lome Health. District. Hoene owner or. 11gn. <br />sed agents signature certifies the followin <br />"I certify that In the perfo► once of. the work for which this permit is hoved, I shall not "Play any person In such MaRnm <br />as to become sstbb��`► 01 orkm 's pensatlon laws of California." <br />Signed.... .............. <br />igned....CrC.'............ <br />......................Owner <br />By....+.....`...........f.........................-.......... Title .......... <br />r <br />} y If other than owner) „ <br />DEPART NT USE ONLY <br />APPLICATION ACCEPTED SY............... .. ._.. _...:. .. .......... DATE ...-.�. <br />BUILDING PERMIT: ISSUED ­ <br />_DATE ................_. s <br />ADDITIONALCOMMENTS......................---................................................................................... _.. ............. <br />....................._.._.....----............---....................... ._........_..............._.........................................................---............ ...... _ <br />Final Inspection by:...:..•.........�j��.1-..-• ............. - _ ... _...... ..................................................... <br />... .. _ <br />Dote .�-�-�- <br />EH 13 2h 1-68 Rev. i SAN JOAQtJt LOCAL HEALTH DISTRICT 8/7� 3.M <br />