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FOR OFFICE USE: <br /> STDAPaI'LlCATION FOR SANITATION PERMIT �� <br /> . _ <br /> lam,f: <br /> (Completo in Trl0- icate) Permit No <br /> ---------=-- --- -- <br /> �- -�------ --------------- Date Issued _�,� <br /> -----------------_-_--__._______...__._.-_-_-__ This Permit Expires i Year From 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 Regulations: <br /> JOB ADDRESS/LOC N -----------_42AZ 'zs,�...-.._._CENSUS TRACTS:7� ------...._. <br /> r -Owner's Name _._ -------------------------- --- ---Phone .----------------------------- <br /> Address ------------ ..... Y----------------------------------------- City --,-5--'f--1 ------------------------------ --------------------------- <br /> I � 4 <br /> Contractor's Name ----e=c 7- G-- - --------- -------------------------------License # ------- -.---- --------. Phone ---------------------..._-_ <br /> Installation will serve: Residence partment House ❑ Commercial ❑Trailer Court ;❑ <br /> 4 / Motel ❑ Other -:------------------------------------------ <br /> Number of living units:__1-__.___Number of bedrooms __- ______Garbage Grinder Lot Size ----7,�_ l <br /> Water Supply: Public System and name ---ZA 10 <br /> �'` Private ❑ <br /> Character of soil to a depth of 3 feet: Sand' Silt❑ Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe '❑ Fill Material ------ ----- If 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 /> I PACKAGE TREATMENT (q-- SEPTIC TANK' Size___ ----------------- Liquid Depth ----------- <br /> Capacity Type 2J__(_,9 __ Materia[4 .,,CYje4e No. Compartments _._ ............... <br /> Distance to nearest: Well _. i2d+/`________________Foundation ---/.67 Prop. Line ._-. ......... Qr <br /> LEACHING LINE U-�- No. of Lines __1— Length. of each line___ ---- ------ Total Length -----Z�— <br /> 'D' Box ----- Type Filter Material ZpOi1Depth Filter Material ------ `f___________________________ <br /> Distance to nearest: Well ------------------------ Foundation -- --------------------- Property Line ----------------------- <br /> SEEPAGE <br /> _____________SEEPAGE PIT C ] Depth -------------------- Diameter ---------------- Number ---------------------------- Rock Filled Yes ❑ No i❑ <br /> Water Table Depth ------------------------------------------------Rock Size ---------------------------- <br /> Distance to nearest: Well -----------------------------------------Foundation -------------------- Prop. Line --------.-............ <br /> REPAIR/ADDITION(Prev. Sanitation Permit# -------------------------------- Date ----------------------------------) <br /> SepticTank (Specify Requirements) -------------------- --------------------------------------------------------------------­--------------------------- <br /> ` Disposal Field (Specify Requirements) -----------=-------------------------------------------------------------------------------- ------------------------•------------- <br /> ------------ -- -----------------"=----------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> i <br /> --------------------- ------------------------------------------=------------------------------------------------------ -------------------------------------- <br /> (Draw existing and required addition on reverse side) <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 /> "1 certify tat-in the performance of the work for which this permit is issued, I shall not employ any person in such manner <br /> ,,as to b e sub' ct to kman's Compensation laws of California." <br /> �G Owner <br /> Sign ------------ - I c`:---- ----------- ---- <br /> Gr`_ . ----� ------------------------------------------ Title <br /> ------ ------------------------------------------------ <br /> .. <br /> other than owner) <br /> FOR D PA:RTMENT USE ONLY <br /> APPLICATION ACCEPTED BY -------- ------•--- ----------------------------------------------- DATE ----------- <br /> BUILDING PERMIT ISSUED ----------------------------------------------------------- ------------------------------=--------------DATE ------------- ----------- ----------------- <br /> ADDITIONALCOMMENTS -------------------------•--------------------------------------------------------------------------------------------------------=--------------------------- <br /> ------------------------------------------------- - - -- - ------ <br /> - - ---------------------------- ----------------- <br /> Final Inspection by: ----------_- / �� -�� <br /> --------------------------------------- ------------------------------ -- <br /> -�- -%--�� -------------------------------�------------------------------------.._.Date -- - -----�----------------------- --- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> E. H. 9 1-'68 Rev. 5M <br />