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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Trlplicatel Permit No. <br /> ........................................ this Permit Expires 1 Year from Date Issued Date Issued_.................7S <br /> Application is hereby made to the Son Joaquin Local Health District for a <br /> the work he <br /> described. This application is made in compliance with County Ordinance Nom549 and existing Rulesrit to constrL;ct andtand Regula ons:ein <br /> JOB ADDRESS/LOCATIO f../.3:5 S� ,{,1i��� .. <br /> mfr...-.CENSUS TRA <br /> Owner's Name ...__... ...h_ J/l(1�5_ _ CT ..................._...... <br /> ��®® <br /> Address �. �ldp --•Z..._.....rcity Y, one .................................... <br /> Contractor's Name . »r: .........•---•...• .................... <br /> - License # .. <br /> • ............... Phone <br /> 7-.-,....__ .. <br /> Installation will serve: Residence partment House IJ Commercial QTraller Court <br /> i I <br /> Motel 0 Other.---------------------------------- <br /> Number of living units:_'_ _-....Number of bedrooms z <br /> Garbage Grinder:.... Lot Size a,. <br /> Water Supply: Public System and name ....................... <br /> .__._.._.r ........................... <br /> of 3depthet: Sa .........................Private <br /> Character of soil to a dept ❑ <br /> ,.�nd 0 Silt 0- Clay 0 Peat 0 Sandy Loom 0 Clay Loam 0 <br /> Hardpan p Adobe 0 Fill Material ............ I# es <br /> Y ,type ............... ..... <br /> ....... <br /> (Plot plan, showing size of lot, locat€ontaf system in relation to wells, buildings, etc. must be placed on reverse side.} <br /> NEW INSTALLATION. <br /> (No septic tank or.seepage pit permitted if public sewer 1s available within 200 feet,) <br /> PACKAGE TREATMENT ( ] � <br /> SEPTIC TANK{ ] Size.....:---•---•-- <br /> . Liquid Depth � <br /> -•-•--•-•................ <br /> Capacity - ... Material.--- ....-•••... No. Com N <br /> - Type ------•--•-----•- Compartments <br /> Distance. to nearest: Well ._._=.Foundation Prop. Line <br /> LEACHING LINE ( J No. of Lines ..__.._ t -_--- Lent ...... <br /> ---.-..�-- ------•----- Length of each line._...__..._•_-•-•- - .- ••-- Total Length{ g ............................ L4 <br /> 'D' Box ............ Type Filter Material ....................Depth Filter Material <br /> Distance to�nearest: Well ------------------------ Foundation ......___••-------.:.... Property Line :.. r <br /> SEEPAGE PIT O .....................Y <br /> Depth -------------------- <br /> Diameter ................ Number ............................ Rock Filled Yea No <br /> t 0. <br /> Water Table Depth <br /> -----------------------Rock Size <br /> Distance to nearest: Well --- ----------Foundation . Prop. Line ...................... <br /> REPAIR/ADDITION(Prov. Sanitation Permit Dat <br /> ....... - . .... <br /> . . <br /> Septic Tank ISpecify Requirements) <br /> z <br /> Disposal Field (Specify Requirements) <br /> ----------- --------_-- <br /> ----------------------------- <br /> --------------- ---------•------ ----- .- <br /> .---•--------------------• i <br /> •---•----------------_---- _ ......................................... <br /> (Draw existing and required addition on reverse side) <br /> l hereby certify that 1 have prepared this application and that the work will be dons In accordance with San n <br /> oaqui <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin local Health:District. Home owner Jqui <br /> sed agents signature certifies the foil wing: or Ilcen7 <br /> "I certify 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 subject to Workman's Compensation laws of California." <br /> Signed Owner <br /> _..._ <br /> BY •.-..-._. . --------------­--­------- Title --------- <br /> r than owner! <br /> t} FODEPARTMENT USE ONLY <br /> BUILDING PERMIT ISSUED ............ -�--- <br /> APPLICATION ACCEPTED BY ------------ ---- <br /> ------------- --- - -- - - -••------ .................................... DATE L.Y. 7--,5------ <br /> ..• ••------•-• <br /> ADDITIONAL COMMENTS ---- -.. . •-•----------••-----•----------------- .........--------..--DATE . ---------•- ---------• <br /> .........................•- <br /> -------------------------------------------• --------•--------••---••---.--------•--- _--. ------------- ----•--- --------•.._..........................................._............... <br /> FinalInspection b -------••-•............................................................... <br /> EH 13 2!t 1-68 Rev. ---------Date ----•---- <br /> SAN JOAQUIN. LOCAL HEALTH DISTRICT $/?t, 3M <br />