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FOR OFFICE USE: , PPLICATION FOR SANITATION PERMIT 6 <br />--------------------------------------------------------- Permit- Permit No. lf <br /> / (Complete in Triplicate) <br />----------------------------------------- ------------- - _r__4`i`�..:�9 a <br />--------------------------------------------------------- This Permit Expires 1 Year From Date issued Date Issued <br /> Application is erebymade to the San oaquin Loc ealth District for a per to construct and install the work herein <br /> described. h-s I' on ' ma i com ith County Ordinance No. 349 and existing Rules and Regulations: <br /> .p� e <br /> JOB ADD S ATIO ---- --------- ----- -- � �--��z.,.*- -4*.----0,4--CENSUS--CENSUS TRACT ------------------- <br /> Owner's Name _ J 6--A--------------------------------------- ----------Phone.`, z_" fir ------ <br /> AddressT �------------------------ `�`r'J `�` .-- City __--------------------------------------------------------- --------------- <br /> ¢¢ <br /> Contractor's Name ---- ------`----- ------------License # ------------------------ Phone <br /> i <br /> Installation will serve: Residence ❑ Apartment House❑ Commercial❑Trailer Court i❑ <br /> Motel []Other _1'6w G4---SFD P_- 6 .Z <br /> Number of living units:_ Number of bedrooms ------------Garbage Grinder __________ Lot Size ____________________________________________ <br /> Water Supply: Public System and name ---------------------- -------------- ------- ---------------------•-------------------`— ------- t- sivate <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt Clay � Peat❑ Sandy Loam ❑ Clay Loam.[] <br /> r __ n-r <br /> . - <br /> Hardpan ❑ Adobe []e FiII Materia! ----"'—"_-'l'f 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'K Size----------- ------------ ------- Liquid Depth ----��_. --------------- I, <br /> Capacity/ �_�7 .:1_ Type _ Mi�rere ia)- .- No. Compartments ---y----------- € <br /> Q .�.F <br /> Distance to nearest. Well -------LjCV........ ----Foundation ----------- Prop. Line ------ <br /> LEACHING <br /> ___--LEACHING LINE No. of Lines -------/------------___ Length of each line------- ----------- Tota! Length :------F-Q-------------- <br /> r <br /> 'D' Box ------------ Type Filter Material .-404r&____Depth FilterMaterial ------1_.-7____________________---._.__._ <br /> Distance to nearest: Well ------ Foundation -_-_!-0.1__--_______ Property me, ----- _-____. _ <br /> ---- <br /> SEEPAGE PIT Depth le Yes No <br /> p --�� - Diameter/��-------- Number ��{�� � ---��___ Rock Fili ` (3 <br /> Water Table Depth ------------------------------------------------Rock Size <br /> Distance to nearest: Well _.__,l_Gtr_-_____I- <br /> REPAIR/ADDITION(Prev. Sanitation Permit# Date ------------ -------------------- <br /> _____,____Foundation -----/- __�___ Prop lute _____ __.___.. <br /> �-•-----•--------------------- ------_--_---- _- ) <br /> Septic Tank (Specify Requirements) ..........____- ________ <br /> -------------------------------------------------------------- ------------------------- <br /> Disposal Field {Specify Requirements) ----------- -------------------------I ------------------------------------------------ ----------- <br /> �" r-----------'" = "e -------------------- ------------- --- - -----------------------------_---------------------- <br /> ----------- ---- - --------------------- <br /> s - ---------------_--------- <br /> 1 b_4 <br /> -- <br /> `��� {E` ; (Draw existingand required addition ori re rse side) <br /> I hereby certify that have prep reed` this application and that the work will be done in accordance with San Joaquin <br /> County .Ordinances, State Laws, and iltules and Regulations of the Sbp Joaquin Local Health District. Home owner or licen- <br /> sed agerits-signatur certifies the following: <br /> "I certify`h%i id�he performance cftlhe work.forWF i h this,permit is issued, I shall not employ any person in such manner <br /> as to become ubiect,to,Workman's_Compensatian lags of California." <br /> Signed ------------------------------ ------- ------------------- Owner <br /> By ------------------ ° ---------------- Title "` - <br /> ---------------------------------------------- <br /> (If other n owner) <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --- --73----- ------------------------------------------------------------ DATE -------------------- , <br /> BUILDING PERMIT ISSUED - ------ ---------------------------------------------------- -----------------------------=--------- ----DATE ----------- ----------------------------- <br /> ADDITIONALCOMMENTS ---------------------------------------------------------------•• ------------------------------------------------------------ ---=----------•---------------- <br /> ---------------------------------- -- -------- --------------------- ----------------------------------------------------------------------------------- <br /> Final inspection by: - .` -- -- -------- - - ---- -- - Date ------------------------ <br /> SAN JOAQUIIv LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />