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FOR OFFICE USE: <br /> APPLICATION FOR SANITATION PERMIT <br /> (Complete in Triplicate) Permit No. ..7........ .... <br /> J <br /> This Permit Expires I Year From bate Issued <br /> 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 applicatio ise/in compliance with County Ordinance No. 544 and existing Rules and Regulations: <br /> i JOB ADDRESS/LOCATION .-- �., l tl /�: './... ........ ....................CENSUS TRACT ..5.77" <br /> Owner's Name ...... ._ 'U. _....__.. !lE}. T,tLJ_... .............Phone ,_ ........................ <br /> .............. <br /> Address ---r------ ---5?.1/).1 _... ...........---•---------_-------.------- --_- City ..............._................................ <br /> Contractor'sName �..<_�,.../ lf�1!:. --- -- .... ..........License <br /> Installation will serve: Residence XrApartment House❑ Commercial ❑Trailer Court ❑ . <br /> Motel [] Other -----------------------•--•=-•----......-• G <br /> Number of living units:../------- Number of bedrooms .......Garbage Grinder .lot Size ........... <br /> Water Supply: Public System and name .................... ............................... ---------- - _.._........... Private ❑ <br /> Character of soil to a depth of 3 feet: Sand❑ Silt[:1 Clay -[ Peat-0— Sandy Loam E] Clay loam E) <br />} Hardpan ❑ Adobe [] Fill Material ._........- If yes, type ............................ <br />{ (Piot pian, showing size of lot, location of system relationvto wells, buildings, etc: must be placed on reverse side.[ <br /> NEW INSTALLATION: (No septic tank or seep a pit permitted if public sewer is available within 200 feet,) <br /> PACKAGE T.. �' al! <br /> TREATMENT [ ] SEPTIC TAMC � Size....5'_1C.J.l�,.}�-6. .......... Liquid Depth ...�f-�._.---....._.... p, <br /> Ca cit !/�..... Type ._.- No. Compartments <br /> istance to nearest: Well . . ................................Foundation ./.G.,.-._:.•..... Prop. LineP_ ....._....... �- <br /> j LEACHING LINE,- No. of Lines - ... .... .. .. length of each .line ........... . Total Length ...... <br /> D' Box _.-J .. . Type Filter Material Depth Filter Materia( ..�1�__....__-____-_-_______.•._----- <br /> ` o 1 <br /> Distance to nearest: Well ..-... *______________ Foundation /�4!�!.........._.... Property Line _... <br /> SEEPAGE PIT [ I •.. Depth .. . .. ......... Diameter ................ Number ....................._...... Rock Filled Yes C] No <br /> CE <br /> Water Table Depth ------------ _.............__........:---.._Rock Size ........ --------_------------ <br /> f ter' Distance to nearest: Well ........................................Foundation .............. Prop. line ...-....... <br /> .......... <br /> 1 REPAIR/ADDITION(Prev. Sanitation Permit# ---_-__.._......... .. .................. Date .................................. <br />� .....Septic Tank (Specify Requirements) --- ......-• -------•-•--------------------••---••----------- --------- ------------I.,.................. ------ <br /> Disposal Field`{Specify- Requirements) ---------- - ------------------__------- ............. .................................................. <br /> ---- ---------------------------------------------------- _ _.-.._......._..--_....._.............................._......-- <br /> - ..... .............. ......... .......... . ..................................................................... - .............-.............. .................. ....... <br /> {Drdw 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 signafiure_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 subject Work n's Compensation laws of Cgiifornia." <br /> Signed . .. . <br /> - �- - �� ---•- -;/• ---• � -;:..-----.._...---.-- -------------._. Owner <br /> BY .......:...... - . . 7itie . .... . <br /> ...... .._....: . ..... ............_.. ............................_..... <br /> (If other than owner) � = '' <br /> - ---FOR -DEPARTMENT_ USE ONLY - <br /> APPLICATION ACCEPTED BY .- .. 1 .. 0........................ . .. ---•-••.. ------ --------- ......., ..'_. DATE �- Z�•'�d!' --------- <br /> BUILDING PERMIT—ISSUED = x.. .,DATE ... -.......... ---- <br /> . ............................................. ................... <br /> ADDITIONAL COMMENTS .,.... <br /> -- <br /> I Final Insp -.x Date . . <br /> --SAN JOAQUIN LOCAL HEALTH DISTRICT W <br /> 1l b •i w � waw \t 1,' <br />