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+a 4 <br /> LOROFIICECE USE: gpp�i�ATiON FOR SANITATION PERMIT <br /> ..n d,' � Permit---. ------ (Complete in Triplicate) <br /> --------------------- Date Issued -.��-��Y-7�-------- This Permit Expires 1Year From ate slue- struct and <br /> ---- - ------------------------- <br /> 1 the work herein <br /> Hecilth <br /> rmit to con <br /> A plication is hereby made to the San Joaquin Local i h County District <br /> dinan a No. 549 and existing Rulestalnd Regulations.. <br /> Application application is made in compliance <br /> described. This app �-'-- <br /> CENSUS TRACT <br /> 7 = <br /> JOB ADDRESS/LO %TION _. phone _��-,5-- <br /> - <br /> Owner's Name --------- <br /> ----- --------------- <br /> ------ ---- ----°--•--. City ----- - ---- - --- <br /> ---- <br /> Address -1-3-01 <br /> ----------- }---- Phone -------- <br /> ------------------------------ <br /> ----.License ----- ------ ------ -- <br /> Contractor's Name --_-------- �- --- -•--- -- - - ---- <br /> Residence EApartment House❑ Commercial ❑Trailer Court l❑ <br /> Installation will serve: 4 E <br /> Motel ❑Other -------------------------------------------- <br /> j -_Garbage Grinder ( ---- Lot Size <br /> Number of living units:-_1-- ---- Number of bedrooms --,_ _- -�_ F --------Private ❑ <br /> Public System and name -_ �-� --- ----- - Pe----- ----------------------- --'---------------. <br /> Water Supply: y at Sandy Loam Clay Loam ❑ <br /> Character of soil to a depth of 3 feet: Sand'M Silt❑ Clay ❑ ❑ <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ if yes,type <br /> { <br /> (Plot plan, showing size of lot,[ocation of system in relation to wells, <br /> buildings, etc. must be placed on reverse side.] W <br /> ' ermined '9f public sewer is available within 200 feet,i <br /> a NEW INSTALLATION: (No septic tank or seepage pit p < <br /> t 5ize_�d-�--�-�--C` -�- --•------------ Liquid Depth --- -- -- ------ ----.---=- <br /> PACKAGE TREATMENT SEPTIC TANK <br /> 2 <br /> Capacity�_ - TYpe - -- ------ --- Material---------------------- No. Compartments <br /> -- <br /> _. <br /> Foundation ��� a ---�---'Prop. Line _-_--- --_. <br /> Distance to nearest: Weil �'�" -------------------- <br /> 11 1 Total Length - <br /> LEACHING LINE No, of Lines . <br /> ---- ------ ------ - Length of each line__. 1-�----------"- -.-'' <br /> U.cXMtM _Ae th Filter Material 'G�� <br /> Box ---- TYPe Filter Material 1------- p a-" --t <br /> x(10 1 =--__- Property Line ------------------------ <br /> Distance <br /> '�---- ---------- <br /> Distance to nearest: Well ----------- -_------- Foundation - --- ---- I <br /> 3 <br /> --- --- Diameter Number --------------- ------- ---- Rock Filled Yes ❑ No i❑ <br /> SEEPAGE PIT ( ] Depth ---------------- <br /> ��— --Rock Size ------I---------- -------------- <br /> Water Table Depth -_ <br /> R Foundation - Prop. Line ---------------------- <br /> Distance to nearest: We --------------------------------------- <br /> • --- - Date -----------------------------------] <br /> - -------------------- <br /> REPAfItfADDITION(Prev. Sanitation Permit -------•�------ - . <br /> ---------------------------------------------- <br /> Septic Tank (Specify Requirements) -__--------------- <br /> --------------------------------- <br /> - ---------------------------------- <br /> ------ --------------------------------- -- <br /> Disposal Field (Specify Requirements ___-!--- - r . <br /> - ------------------------ <br /> ------------- <br /> y <br /> ----------------- --------------------------------------------- <br /> (Draw existing and required addition on reverse sE ey <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin <br /> County Ordinances, State Laws, and .Rules and Regulations of the San Joaquin Local Health District.Home owner or licen- <br /> sed agents signature certifies the following: <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 blect to Workman's Compensation la s of California." <br /> SignXr� --------- <br /> ed <br /> ----- --------------------- <br /> Title - -- ------ <br /> (If other than owners <br /> FOR DEPARTMENT►VSE ONLY <br /> DATE <br /> +la b <br /> APPLICATION ACCEPTED BY -- --- ----- -- ----- <br /> . - DATA __.. --------------------------- <br /> ----------- <br /> BUILDING PERMIT ISSUED qq <br /> ADDITIONAL COMMENTS T -+11 I - ---- ---- --------------------- <br /> ----- -- ---- - ----{�}ww•� ,, f <br /> - -------- -------------------------------- ------ ----------------------------------------- r------------ ----------------------------------------- -------- <br /> ------ <br /> - ----- --- - -------------------------- -------- <br /> -- - - `� -- <br /> ate <br /> Final Inspection by: - <br /> -- <br /> ---------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> I E. H. 9 1-'68 Rev. 5M <br />