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APPLICATION FOR SANITATION PERMIT <br />.......................................................... (Complete In Trlpflcotel Permit No. ...7.� <br />...............................I......................... This Permit Explres 3 Year 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. This application Is made In compliance with County Ordinance No. 549 and existing Rules and Regulatlonsr <br /> JOB ADDRESS/LOCAT14. .........� .F.a �.�......60.� .. ....CENSUS TRACT ..... ... .. . . <br /> Ov ner's .Name ....... - ...... ..:C14� -. ... .. . ............... hone <br /> Address ...-... ., c� ........ e..-.... _ ........ . Ci ..................... . .................. <br /> Contractor's Name . .A .p Ice'-`licenseo` �v (f,�...... Phone . .. p�0.. ..- <br /> Installation will serve_s_ Residence (Apartment House Q Commercial❑Traller Covrt 0 <br /> Motel❑Other............................................ <br /> Number of living units:......... Number of bedr ms ., .....Ga ge Grinder _" .. Lot Size ..� .. ,/� ....... <br /> Water Supply, Public System and name ... ......Lw&..........-...................................................Prlvc"❑ <br /> Character 4 soil to a depth of 3 feet: Sand❑ Silt❑ Clay ❑ Peat 0 Sandy Loam [❑ Clay Loam ❑ <br /> Hardpan❑ Adobe)X Fill Material ............If yeas type............... ............ d <br /> (Plot Plan,'showing size of lot, location of system in relation to wells, buildings, etc.r must be, placed on reverse side.) <br /> NEW INSTALLATIONe (No septic tank or seepage pit permitted If public sewer is available within 200 feet,) <br /> PACKAGE TREATMENT ( ] SEPTIC TANK Size. A`,t .frx*�.. .... ..:.... Liquid Depth .._�........... <br /> ...... . <br /> Capacity/ Q;Df. Type . .. . .. Material.. ._...-_-.... No. Compartments ..si............... <br /> D€stento to nearest-;Well ....Foundation s .. ....... Prop. Line ..: <br /> LEACHING LINE -4W No.of Lines --�•--_---.. Langtli of"eaifi line.' . , .. ........ Total Length 1A..0.............. <br /> 'D' Box ....4t. Type Filter Material _ '.....Dep'th` Filter Materlal' ..Z ................................ <br /> • , Distance to nearest: Well sem` Foundation. .1:F. ........ Property Line .. ..�......... <br /> .R <br /> SEEPAGE PIT ' Depth c ......... Diameter j...... Number.__-QZ..................Rock Filled Yes 9k No <br /> Water Table Depth ....._. .. . <br /> f .......Rock Size .set <br /> Dlstance--to,nearestc. ......Fou4clation-.IAf.......... Prop. Line ........... <br /> REPAIR/AgDITION(Prov. Sanitation Permit# ............................................ Date ..................................I <br /> SepticTank (Specify Requirements) 2.....................................................................«....»..........................._. ..........._................ <br /> DisposalField, (Specify Requirements) ...................... ........... ............................................................................................... <br /> ......................................1......kD ..... ... ....._................_ ........ .�l. ....-.. ...._...-•.........................--- ................. <br /> ._.... .... ... .... ............ <br /> (Draw existing and required addition ori reverse side) <br /> I hereby certify that 1 have prepared this application and that time wank` will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Hants owner or licen. <br /> sed agents signature certifies Ilse following: r—�. <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." CIAREmCps SEPTIC & Si'tVER SERVICE <br /> Signed • ......./Lir,.....................•-......... Owner . Oro 5tnci nn, Cz'.ifi. 95205 <br /> ............... <br /> Ph.ar x3209 <br /> By ........ ................... .. Title .................--........................r s!_.....267I1T <br /> (lf other than owner �J <br /> FOR DEPARTMFNT USE ONLY <br /> APPLICATION ACCEPTED BY ..--- : . <br /> .. t– <br /> QATE . <br /> a <br /> BUILDING PERMIT ISSUED _...._...............: ..-._.e....... •..............................•---... -•.... ............................. <br /> ADDITIONA��OMMENT . ........... . . . :....... ............. ...............................:..:,_...................................................... <br /> ......./�J�:................ _ ..-•-•--...................-.......-.......-..----.................................**.... ......... <br /> Final Inspection by: ..-.. ... ------ .... <br /> -- .............................................................Date .�. .�./P, .....--......-.... <br /> iii 13 2a 1-'0 JO IN LOCAL HEALTH DISTRICT <br />