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FOR OFFICE USE: % <br /> - APPLICATION FOR SANITATION PERMIT <br /> - �H <br /> F• (Complete in Triplicate) Permit No: 7 �_---y_Y 3 <br /> ____________________..____.___.--_ _ ------._-------- This Permit Expires ] Year From Date)slued <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 application is made in com01 <br /> pliance with County Ordinance No. 549 and existing Rules and Regulations: <br /> JOB ADDRESS/LOCATION .' TJ11;1 � --------------------------------------------CENSUS TRACT --•------------------------ <br /> Owner's Name -". � b Phone <br /> Address ----%5'0 11-7-4�--=------------------------------------------------------------------------- City 1.7XW10t�------------------------------------------- <br /> Contractor's Name r - -- // ------------------------ License # _ Phone '':2AW5 <br /> Installation will serve: Residence XApartment House-E] Commercial ❑Trailer Court <br /> r <br /> Motel ❑Other ----------------------•--------------------- <br /> Number of living units:----/---- Number of bedrooms &-______Garbage Grinde;,� A'--- Lot Size , _.P--------------- <br /> Water Supply: Public System and name tt I <br /> r-----------------Private <br /> Character of soil to a depth of 3 feet: Sand'❑ Silt E] Clay ❑ Peat❑ Sandy Loam ❑ Clay Loam <br /> Hardpan ❑ Adobe ❑ Fill Material ------------ If yes,type ----_______________________ I <br /> i <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`publi sewer is available within 200 feet,) <br /> PACKAGE TREATMENT [ ] SEPTIC TANK Size__ - `�� 4' _�---_______.______._ Liquid Depth -- --------------- <br /> Capacity �� _- <br /> p y� -.--.--- Typ2y __ Material_60,00 4---- No. Compartments --I ----•-•___--- <br /> Distance to nearest: Well /-�________________________Foundation -1'C�_/________ Prop. Line <br /> LEACHING LINE No. of Lines ---�______________ Length of each line-f _._ f r <br /> Total Length <br /> D' Box _ _ <br /> Type Filter Material/ �Depth Filter Material� '� � <br /> Distance to nearest: Well -_ _�_-_______ Foundation _ _ ----f_________ Property Line _ _ .�___._._.___ 1 <br /> •-•J el I <br /> SEEPAGE PIT r Depth { _-- -______ Diameter ��t7-____ Number ----�_ ____-_-----_--__ Rock Filled Yes ° No. <br /> 'r T ... /� � G> , <br /> Water TabletDepth ____- �,---------------------------- -----Rock Size _ ---------------- <br /> Distance to nearest.est: Well" _.__ _ �� __Foundation "(�� � <br /> �-� �------------------- -- �-- ---,- Prop. Line -[�--------�--� a <br /> REPAIR/ADDITION(Prev. Sanitation hermit# ___.__.-.___-______# J�____"Date'______?________________________ ) S <br /> Septic Tank (Specify Requirements) ---------------------------------------------- I------ ---------I---------------- r• ---•------------------•-----•---- <br /> Disposal Field (Specify Requirements) -------------------------- __________-________________ - r <br /> ---:---= ----------- --------------- <br /> -------------------- - ' -------------------------------------- Ii <br /> -------- -- ----------------------------- - <br /> --------------------------------------------------- <br /> (Draw existing and required addition on reverse side)1*_ <br /> 1 hereby certify that I have preparedthis ppplicatio annd'thct,thi 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 subject to Workman's Compensation lawsofi California." <br /> Signed ---- ----- ------------- - ---- -- --- -- ------------------------------------ Owner <br /> BY = Titles <br /> t er than owner) } <br /> PA_itTMENT USE ONLY <br /> APPLICATION ACCEPTED BY --------- _ , --w- <br /> ------------------------------------------------------ <br /> ------------------ - ------------ --------- -- - DATE --------BUILDING PERMIT ISSUED /- ------------- <br /> ----- _ -------- ------------- ------------------------------------------- <br /> ADDITIONAL COMMENTS ------ ? - ---- --- ----- <br /> - <br /> --- - <br /> --- ------ - --------- <br /> ------------------ --------------- ------------Rif ---------------------------------- - ------ <br /> - <br /> -- ----------------- L ------------------ ------------------------- <br /> Final Inspection by: -------------------------------------------------------------------------Date —, .-------------- <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> w <br /> E. H. 9 1-'6$ Rev. 5M �!'\'1..'\ , <4 -,� , * .. _ .. ` <br />