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APPLICATION FOR SANITATION PERMIT ' f' <br /> FOR OFFICE USE: Permit No: J,IQ'-I/L <br /> ------------- <br /> ---------------------------- ----------- (complete in Triplicate) ; <br /> Date issued <br /> This Permit Expires 1 Year From Date issued <br /> -------- <br /> u t Ordinance No. 549 an existing Rules arid Regulations: <br /> ;s hereby made to the San Joaquin"Local'Health Di <br /> strict for a permit to construct and install the,w'ork herein <br /> Application , <br /> described. This application is made in compliance with 4 CENSUS TRACT ---- I'� <br /> -/ ------ ----- --- -- .. <br /> �- - - � h r <br /> JOB ADDRESS/LOC 10 z-- ---- -- Phoneyla to---- <br /> ------- i <br /> -- ----- ---------------------- <br /> Owner's Name _ - -- ---- ------ ty <br /> Ci i' <br /> - --- - <br /> 4�i<G��3� -- <br /> Address -� "a-. --- ---- ---- -, --- - ----- ense # <br /> .__ Phone -;' <br /> Lic <br /> Contractor's Name _ <br /> Residence ❑ Apartment House❑ Commercial ❑Trailer Court 0y. <br /> Installation will serve: <br /> --------- - <br /> Motel ❑Other --------------------------------- - "".-.".. <br /> Garbo a Grinder ---------- - Lot Size ----- ------------------ <br /> Number of living units:.._. -__" Number of bedrooms --- Private ❑ <br /> ------------------------ <br /> --------- <br /> Water Supply: Public System and name --------- ' Peat❑ Sandy Loam ❑ Clay Loam ❑ <br /> depth of 3 feet: Sand'❑ Silt❑ Clay ❑ <br /> Character of soil to a dep Y e ----------------------------- <br /> Hardpan <br /> ----------------------- --- \ <br /> Hardpan ❑ Adobe ❑ Fill Material If es,typ <br /> location of system in relation to wells, buiidings,,etc. must .be�.piaced on reverse side.) <br /> {Piot plan, showing size of lot, t <br /> it ermitted if public-sewer is available within 200 feet,) <br /> .Q <br /> f NEW INSTALLATION: (No septic tank or seepagep p_ <br /> Size_---------- +---------- ---------- ----- Liquid Depth �' <br /> ' TREATMENT [ ] SEPTIC TANK'[ I --------------------­- <br /> PACKAGE ,. <br /> i -_"- Moterial------ --------------` No. ,Compartments <br /> CapacityType <br /> s -Foundation -'--'---- -` Pra Line - <br /> Distance to nearest: Well _------- ---- <br /> . J Total Length ----- ---------- ----------- <br /> N No. of Lines Length of each line• , t <br /> LEACHING LINE [ a <br /> Type Fester Material --__-_-_" ------ =Depth Filter Materia! `- ------ <br /> D' Sox Yp r Property Line - ------------Nc----- - <br /> ---- <br /> Distance to nearest: Well ----------------------;r Foundation ;-- Rock Filled Yes <br /> ' �_.�--- Diameter - D----- Number ."------ ,� <br /> SEEPAGE PVT Depth , t <br /> L -----°---- --.Rock Size "��-�-�- --•--- ----_ -_ <br /> Water Table Depth "_ _ Q <br /> Il>--------- Prop. Line,;-- --- <br /> Distance to nearest: Well "_ -- <br /> - --_--Foundation <br /> i . <br /> IDate ---------------------------------- <br /> REPAIRJADDITION(Prev. Sanitation Perm+t# i _ I <br /> �, _ ..: .,�,- �-., -------------- <br /> ---- <br /> ---!-------- <br /> F - -------'---------------- - �"'r - p <br /> K.. <br /> Septic Tank{Specify Requ+rements) _._-- "" !� " _ __ <br /> p - ' -------------------------�----- - <br /> ---------------- <br /> s cif Requirements) ----------- <br /> Disposal Field (Spy Y .q <br /> --------------------- <br /> �� ! ' <br /> --------------------- <br /> --- late-�----- <br /> -" (Draw existing and required addition on reverse side( <br /> + application and that the work will be done in accordance with San Joaquin <br /> { I hereby certify that I have prepared this app <br /> County Ordinances, State Laws, and Rules and Regulations of the San Joaquin Local Health District. Home caner or Iicen- <br /> sed agents signature certifies the Following: <br /> in such manner <br /> 6 <br /> 4 <br /> 1 certify that,in the,performance of the work for which <br /> as to become blec Workan'smiP this permit is:.issued, 1 shall not employ any p.erson 1' <br /> i. ensatio l laws of California." <br /> to <br /> 1 <br /> ► -- - --- --- Owner <br /> Signed --- -- <br /> ------------------ <br /> Title <br /> -- -- ---- - , <br /> (if other than n a <br /> + FOR DEPARTMENT USE ONLY <br /> ION ACCEPTED BY . � DATE --- <br /> APPLICAT � ----------------------- ---------- <br /> i ------ ----- <br /> ------------- --------------- <br /> PERMIT ISSUED ---- ------------------- --.e. ------------ <br /> BUILDING <br /> ADDITIONAL COMMENTS "� — <br /> -- - - ------------------ <br /> - - ---- <br /> r, 2-��------ --ii------ - ----------- ----- <br /> ` y - - <br /> -��fr'f 4-:---------- _ --_- -------Date---- ------------ -- <br /> - -- ------- ---------------- --- - <br /> ----- -- ----------- - - -- -------- <br /> ---------------------------- - ----- -- <br /> ------------------- <br /> Final inspection by:�-------------------------------------------------------- <br /> -` - -------------- <br /> � ' 9/ 1 SA JpAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'b8 Rev. 5M <br />